Lymphocyte Cell Lines and Uses Thereof

ABSTRACT

Embodiments described herein relate to compositions including genetically modified CAR cells and uses thereof for treating cancer. Some embodiments of the present disclosure relate to compositions and methods for T cell response enhancement and/or CAR cell preparation. For example, a method may include obtaining cells comprising a CAR and culturing the cells in the presence of an agent that is recognized by the extracellular domain of the CAR.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 62/640,523, filed on Mar. 8, 2018, entitled “Lymphocytecell line and uses thereof”, U.S. Provisional Patent Application No.62/598,024, filed on Dec. 13, 2017, entitled “Chimeric Antigen ReceptorCell Preparation and Uses thereof”, U.S. Provisional Patent ApplicationNo. 62/527,649, filed on Jun. 30, 2017, entitled “Chimeric AntigenReceptor Cell Preparation and Uses thereof”, and U.S. Provisional PatentApplication No. 62/527,140, filed on Jun. 30, 2017, entitled “Modifiedlymphocyte cell line and uses thereof,” which are hereby incorporated byreference in their entirety.

SEQUENCE LISTING INFORMATION

A computer readable textfile, entitled Lymphocyte Cell Lines and UsesThereof “1071-0030US Sequence Listing.txt,” created on or about May 15,2018, with a file size of about 24.5 KB, contains the sequence listingfor this application and is hereby incorporated by reference in itsentirety.

TECHNICAL FIELD

The present disclosure relates to modified cells, in particular tocompositions including the modified cells and uses thereof for treatingdiseases and conditions.

BACKGROUND

Scientists developed chimeric antigen receptors (CARs) for expression onT cells more than 25 years ago. The chimeric antigen receptor (CAR)technology combines an antigen recognition domain of a specific antibodywith an intracellular domain of a T cell receptor (TCR). T cellsgenetically modified with a CAR to target certain malignant tumors havedemonstrated favorable clinical outcomes. During CAR T cell therapy,physicians draw patients' blood and harvest their cytotoxic T cells. Thecells are then re-engineered in a lab, so they can learn how to attackeach patient's particular cancer. The patients are usually treated withchemotherapy before the CAR T cell therapy or during the CAR T celltherapy to wipe out some of their existing immune cells. However,chemotherapy may cause the patients' T cells to drop significantly.While most patients will recover and their immune cells will reachpre-chemo levels in nine months, some patients may not be able togenerate enough T cells for continuous CAR T cell therapy. This puts thelives of these patients at risk. Further, as for CAR T therapy,long-term maintenance of CAR T cells in patient bodies is important forthe prognosis of patients in the treatment of tumors. For example, iflong-term presence of CAR T cells can be maintained, this technology mayeffectively reduce tumor recurrence.

SUMMARY

Embodiments described herein relate to compositions includinggenetically modified CAR cells and uses thereof for treating diseasesand conditions.

Some embodiments of the present disclosure relate to a methodcomprising: providing a cell; introducing a nucleic acid sequenceencoding a CAR and a nucleic acid sequence encoding hTERT, SV40LT, or acombination thereof, into the cell; and culturing the cell in thepresence of an agent that is recognized by the extracellular domain ofthe CAR, thereby producing a modified CAR cell.

In some embodiments, integration of the nucleic acid sequence encodinghTERT, the nucleic acid encoding SV40LT, or a combination thereofincludes genomic integration of the nucleic acid sequence encodinghTERT, a nucleic acid encoding SV40LT, or a combination thereof andconstitutive expression of hTERT, SV40LT, or a combination thereof. Insome embodiments, expression of hTERT, SV40LT, or a combination thereof,is regulated by an inducible expression system. In some embodiments, themethod may further include introducing a nucleic acid sequence encodinga suicide gene into the cell and culturing the CAR cell comprising thesuicide gene and the nucleic acid encoding CAR with a nucleosideanalogue in a manner permitting expression of the suicide gene to renderthe nucleoside analogue cytotoxic. In some embodiments, the cell is a Tcell or a natural killer (NK) cell.

In some embodiments, the CAR comprises an extracellular domain, atransmembrane domain, and an intracellular domain. In some embodiments,the intracellular domain comprises a costimulatory signaling domain thatincludes an intracellular domain of a costimulatory molecule selectedfrom the group consisting of CD27, CD28, 4-1BB, OX40, CD30, CD40, PD-1,ICOS, lymphocyte function-associated antigen-1 (LFA-1), CD2, CD7, LIGHT,NKG2C, B7-H3, and any combination thereof.

In some embodiments, the agent is a regulatory compound that binds anextracellular component of the CAR and mediates a response by the cells,a ligand that binds the extracellular domain of the CAR, an antigen thatthe extracellular domain of the CAR binds, or the extracellular domainof an antigen that the extracellular domain of the CAR binds. In someembodiments, the antigen is Epidermal growth factor receptor (EGFR),Variant III of the epidermal growth factor receptor (EGFRvIII), Humanepidermal growth factor receptor 2 (HER2), Mesothelin (MSLN),Prostate-specific membrane antigen (PSMA), Carcinoembryonic antigen(CEA), Disialoganglioside 2 (GD2), Interleukin-13Ra2 (IL13Rα2),Glypican-3 (GPC3), Carbonic anhydrase IX (CAIX), L1 cell adhesionmolecule (L1-CAM), Cancer antigen 125 (CA125), Cluster ofdifferentiation 133 (CD133), Fibroblast activation protein (FAP),Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folate receptor-α(FR-α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, B-CellMaturation Antigen (BCMA), or CD4.

In some embodiments, the agent is an antibody that binds theextracellular domain of the CAR. In some embodiments, the antibody is ahuman IgG antibody and/or binds a Fab fragment of a human IgG. In someembodiments, the regulatory compound comprises an extracellular domainof at least one of CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3,CD5, or CD4. In some embodiments, the regulatory compound comprises atleast one of amino acid sequences: SEQ IDs: 41-47. In some embodiments,the regulatory compound binds at least one of amino acid sequences: SEQIDs: 21 and 48-53. In some embodiments, the CAR cells comprise at leastone of SEQ ID Nos: 38, 35, 39, and 40.

In some embodiments, the CAR cells cultured in the presence of the agentexhibit about a 1.5 to 2 fold increase in cell growth as compared to theCAR cells cultured in the absence of the agent. In some embodiments, theCAR cells cultured in the presence of the agent exhibit about a 1.5 to 3fold increase in cell growth as compared to the CAR cells cultured inthe absence of the agent. In some embodiments, the CAR cells cultured inthe presence of the agent exhibit about a 2 fold increase in cell growthas compared to the CAR cells cultured in the absence of the agent. Insome embodiments, the cell density of the CAR cells in the culturemedium is at least about 25×104 cells/ml of the cell culture medium. Insome embodiments, the cell density of the CAR cells in the culturemedium is less than about 200×104 cells/ml of the cell culture medium.In some embodiments, the cell density of the CAR cells in the cellculture medium is between about 50×104 to about 200×104 cells/ml of thecell culture medium. In some embodiments, the cell density of the CARcells in the cell culture medium is between about 50×104 to about100×104 cells/ml of cell culture medium.

In some embodiments, the CAR cells are sensitive to a tetracycline fromthe cell culture medium. In some embodiments, the CAR cells comprise athird nucleic acid sequence encoding a reverse tetracyclinetransactivator (rtTA). In some embodiments, expression of hTERT orSV40LT is regulated by the rtTA, such that hTERT or SV40LT is expressedin the presence of tetracycline. In some embodiments, a concentration oftetracycline in the cell culture medium is not less than about 2 μg/ml.In some embodiments, the tetracycline is selected from the groupconsisting of tetracycline, demeclocycline, meclocycline, doxycycline,lymecycline, methacycline, minocycline, oxytetracycline,rolitetracycline, and chlortetracycline. In some embodiments, thetetracycline is doxycycline.

In some embodiments, the CAR cells comprise a fourth nucleic acidsequence encoding a suicide gene, such that when the CAR cells arecultured in the presence of a nucleoside analogue in a manner permittingexpression of the suicide gene, to render the nucleoside analoguecytotoxic to the CAR cells. In some embodiments, the suicide gene isselected from the group consisting of thymidine kinase of herpes simplexvirus, thymidine kinase of varicella zoster virus, and bacterialcytosine deaminase. In some embodiments, the suicide gene is thymidinekinase of herpes simplex virus. In some embodiments, the nucleosideanalogue is selected from the group consisting of ganciclovir,acyclovir, buciclovir, famciclovir, penciclovir, valciclovir,trifluorothymidine, 1-[2-deoxy, 2-fluoro, beta-D-arabinofuranosyl]-5-iodouracil, ara-A, araT 1-beta-D-arabinofuranoxyl thymine,5-ethyl-2′-deoxyuridine, 5-iodo-5′-amino-2,5′-dideoxyuridine,idoxuridine, AZT, AIU, dideoxycytidine, and AraC. In some embodiments,the nucleoside analogue is ganciclovir.

Some embodiments relate to an isolated cell obtained using the methoddescribed herein. Some embodiments relate to a composition comprising apopulation of the isolated cells. Some embodiments relate to a method ofenhancingT cell response in a subject and/or treating a tumor of thesubject, the method comprising: administering an effective amount of thecomposition described herein.

Some embodiments relate to a modified cell comprising a nucleic acidsequence encoding hTERT, a nucleic acid encoding SV40LT, or acombination thereof, wherein integration of the nucleic acid sequenceencoding hTERT, a nucleic acid encoding SV40LT, or a combination thereofincludes genomic integration of the nucleic acid sequence encodinghTERT, the nucleic acid encoding SV40LT, or a combination thereof andconstitutive expression of hTERT, SV40LT, or a combination thereof.

In some embodiments, the modified cell is a T cell and furthercomprising a nucleic acid sequence encoding a CAR, and the modified cellis capable of inhibiting a cell expressing the antigen that the CARrecognizes. In some embodiments, the nucleic acid encoding CAR and thenucleic acid encoding hTERT, a nucleic acid encoding SV40LT, or acombination thereof is expressed as gene products that are separatepolypeptides.

In some embodiments, expression of the nucleic acid sequence encodinghTERT, the nucleic acid encoding SV40LT, or a combination thereof, isregulated by an inducible expression system. In some embodiments, theinducible expression system is a rtTA-TRE system, which increases oractivates the expression of SV40LT gene or hTERT gene, or a combinationthereof. In some embodiments, the modified cell comprises a nucleic acidsequence encoding a suicide gene. In some embodiments, the modified cellis a T cell or an NK cell. In some embodiments, the suicide gene is anHSV-TK system. In some embodiments, the modified cell is a proliferableT cell. In some embodiments, the CAR comprises an extracellular domain,a transmembrane domain, and an intracellular domain, and theextracellular domain binds a tumor antigen. In some embodiments, thetumor antigen includes HER2, CD19, CD20, CD22, Kappa or light chain,CD30, CD33, CD123, CD38, ROR1, ErbB3/4, EGFR, EGFRvIII, EphA2, FAP,carcinoembryonic antigen, EGP2, EGP40, mesothelin, TAG72, PSMA, NKG2Dligands, B7-H6, IL-13 receptor α 2, IL-11 receptor α, MUC1, MUC16, CA9,GD2, GD3, HMW-MAA, CD171, Lewis Y, G250/CAIX, HLA-AI MAGE A1, HLA-A2NY-ESO-1, PSC1, folate receptor-α, CD44v7/8, 8H9, NCAM, VEGF receptors,5T4, Fetal AchR, NKG2D ligands, CD44v6, TEM1, or TEM8. In someembodiments, the intracellular domain comprises a costimulatorysignaling domain that includes an intracellular domain of acostimulatory molecule selected from the group consisting of CD27, CD28,4-1BB, OX40, CD30, CD40, PD-1, ICOS, lymphocyte function-associatedantigen-1 (LFA-1), CD2, CD7, LIGHT, NKG2C, B7-H3, and any combinationthereof. In some embodiments, the intracellular domain comprises a CD3zeta signaling domain. In some embodiments, the TCR gene of the T cellis disrupted such that expression of the endogenous TCR is reduced. Insome embodiments, a targeting vector associated with the TCR gene isintegrated into the genome of the T cell such that the expression of theendogenous TCR is eliminated. In some embodiments, the CD4 gene of the Tcell is disrupted such that expression of the endogenous CD4 is reduced.In some embodiments, an antigen binding domain of the CAR binds amolecule on the surface of an HIV. In some embodiments, hTERT has asequence of SEQ ID NO: 6, and SV40LT has a sequence of SEQ ID NO: 7.

Some embodiments relate to a method of generating a CAR T cell, themethod comprising: proliferating a T cell by transferring one or morenucleic acid sequences to the T cell to obtain proliferable T cells; andintroducing a nucleic acid sequence encoding a CAR into the proliferatedT cells to obtain CAR T cells, the CAR comprising an extracellulardomain, a transmembrane domain, and an intracellular domain.

In some embodiments, the proliferated T cells are any of the modified Tcell described herein. In some embodiments, the one or more nucleic acidsequences comprise Tet-inducible HPV16-E6/E7 expression system. In someembodiments, the T cell is a primary T cell extracted from a subject. Insome embodiments, the T cell is a T cell having decreased immunogenicityas compared to a corresponding wild-type T cell in response to a T celltransfusion. Some embodiments relate to a method of treating a diseaseor condition, the method comprising: administering to the human patienta pharmaceutical composition comprising the modified cells describedherein. In some embodiments, the disease or condition is AIDS, and thepharmaceutical composition comprises cells including a CAR with anantigen binding domain that binds a molecule on the surface of the HIV.In some embodiments, the disease or condition is cancer, and thepharmaceutical composition comprises modified cells including a CAR withan antigen binding domain of the CAR binds a molecule on a cancer cell,and the number of endogenous TCR on the cells is reduced. In someembodiments, the nucleic acid encoding the CAR is integrated into thegenome of the T cell.

Some embodiments relate to a CAR T cell comprising: a nucleic acidsequence encoding a CAR that comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule,wherein the TCR gene of the T cell is disrupted such that expression ofthe TCR is reduced or eliminated. In some embodiments, the CAR T cellcomprises a modified T cell described herein.

Some embodiments relate to a CAR T cell comprising: a nucleic acidsequence encoding a CAR that comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule,wherein the CD4 gene of the T cell is disrupted such that expression ofthe endogenous CD4 is reduced. In some embodiments, an antigen bindingdomain of the CAR binds a molecule on the surface of the HIV. In someembodiments, the CAR-T cell comprises a modified T cell describedherein.

Some embodiments relate to a method of producing conditionallyproliferable T cells, the method comprising: transferring one or morenucleic acid sequences to the T cells to obtain proliferable T cells,wherein the one or more nucleic acid sequences encode a peptide suchthat expression of the peptide causes the T cells to become proliferableT cells, and the peptide is regulated by an inducible expression system,an inducible suicide system, or a combination thereof. In someembodiments, the peptide is hTERT, SV40LT, or a combination thereof. Insome embodiments, the inducible expression system is the rtTA-TREsystem. In some embodiments, the inducible suicide system is an HSV-TKsystem or an inducible caspase-9 system.

Some embodiments relate to a method of treating a disease or condition,the method comprising: preparing conditionally proliferable T cellsusing the method described herein; culturing the conditionallyproliferable T cells with a medium containing tetracycline ordoxycycline; culturing the conditionally proliferable T cell with amedium without any the tetracycline or doxycycline; obtaining T cells ofwhich the expression of SV40LT gene or hTERT gene is reduced; andadministering to a subject in need thereof, a pharmaceutical compositioncomprising the T cells.

Some embodiments relate to a pharmaceutical composition includingproliferable T cells obtained using the method described herein for usein the treatment of a disease or condition comprising: preparingconditionally proliferable T cells using the method described herein;culturing the conditionally proliferable T cells with a mediumcontaining tetracycline or doxycycline; culturing the conditionallyproliferable T cell with a medium without any tetracycline ordoxycycline; obtaining T cells of which the expression of SV40LT gene orhTERT gene is reduced; and administering to a subject a pharmaceuticalcomposition comprising the T cells. In some embodiments, the method mayfurther include administering ganciclovir to the subject in response toa certain predetermined condition.

Some embodiments relate to a population of T cells comprising themodified cells, wherein an endogenous gene associated with abiosynthesis or transportation pathway of the TCR gene of the modifiedcell is disrupted such that expression of the endogenous TCR is reduced.

Some embodiments relate to a population of T cells comprising themodified cells, wherein an endogenous gene associated with abiosynthesis or transportation pathway of the PD-1 gene of the modifiedcell is disrupted such that expression of the endogenous TCR is reduced.In some embodiments, the modified cell comprises a nucleic acid sequencethat encodes a truncated PD-1 that reduces an inhibitory effect ofprogrammed death ligand 1 (PD-L1) on a human T cell.

Some embodiments relate to a method comprising: providing cellscomprising a CAR, and culturing the cells in the presence of an agentthat the extracellular domain of the CAR recognizes to obtain CAR cells.

Some embodiments relate to a method for in vitro CAR cell preparation,the method comprising: providing cells; introducing a nucleic acidsequence encoding a CAR into the cells to obtain CAR cells; andculturing the CAR cells in the presence of an agent that anextracellular domain of the CAR recognizes to obtain CAR cells.

Some embodiments relate to a method for enriching cells expressing aCAR, the method comprising: providing cells; introducing a nucleic acidsequence encoding a CAR into the cells to obtain cells expressing theCAR (CAR cells) and cells not expressing the CAR; and culturing the CARcells in the presence of an agent that binds an extracellular domain ofthe CAR to enrich the cells expressing the CAR.

Some embodiments relate to a method for in vitro CAR cell preparation,the method comprising the following steps in the following order: (a)introducing a nucleic acid sequence encoding a CAR into cells to obtainCAR cells; (b) culturing the CAR cells using a first medium for apredetermined time; and (c) culturing the CAR cells using a secondmedium, wherein the first medium does not contain an agent, the secondmedium contains the agent, and the agent binds an extracellular domainof the CAR.

In some embodiments, the agent is a regulatory compound that binds theextracellular domain of the CAR and mediates a response by the cells. Insome embodiments, the regulatory compound is a ligand for theextracellular domain of the CAR or an antigen that the extracellulardomain of the CAR binds. In some embodiments, the agent is theextracellular domain of an antigen that the extracellular domain of theCAR binds. In some embodiments, the antigen is Epidermal growth factorreceptor (EGFR), Variant III of the epidermal growth factor receptor(EGFRvIII), Human epidermal growth factor receptor 2 (HER2), Mesothelin(MSLN), Prostate-specific membrane antigen (PSMA), Carcinoembryonicantigen (CEA), Disialoganglioside 2 (GD2), Interleukin-13Ra2 (IL13Rα2),Glypican-3 (GPC3), Carbonic anhydrase IX (CAIX), L1 cell adhesionmolecule (L1-CAM), Cancer antigen 125 (CA125), Cluster ofdifferentiation 133 (CD133), Fibroblast activation protein (FAP),Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folate receptor-α(FR-α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, B-CellMaturation Antigen (BCMA), or CD4. In some embodiments, the regulatorycompound is an antibody that binds the extracellular domain of the CARbinds. In some embodiments, the antibody is a human IgG antibody and/orbinds a Fab fragment of a human IgG. In some embodiments, the regulatorycompound comprises an extracellular domain of at least one of CD19,FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, or CD4. In someembodiments, the regulatory compound comprises at least one of aminoacid sequences: SEQ IDs: 41-47 and 61-63. In some embodiments, theregulatory compound binds at least one of amino acid sequences: SEQ IDs:55, 21, 48, 49, 40, 51-53, and 56-60. In some embodiments, theregulatory compound comprises at least one of GCC, B7-H4, Prostatespecific membrane antigen (PSMA), Carcinoembryonic Antigen (CEA),IL13Ralpha, her-2, CD19, CD20, CD22, CD123, NY-ESO-1, HIV-I Gag, LewisY, Mart-I, gplOO, tyrosinase, WT-I, h TERI, MUC16, mesothelin, MIC-A,MIC-B, estrogen, progesterone, RON, or one or more members of theULBP/RAETI family.

In some embodiments, the costimulatory molecule of CAR comprises atleast one of CD27, CD28, 4-IBB, OX40, CD30, CD40, PD-L ICOS, lymphocytefunction-associated antigen-I (LFA-1), CD2, CD7, LIGHT, NKG2C, or B7-H3.In some embodiments, the CAR comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule. Insome embodiments, the cells are an NK cell or a T cell, or a combinationthereof. In some embodiments, the regulatory compound is a solubleantigen generated by a eukaryotic system or a bacterial expressionsystem.

In some embodiments, after culturing the CAR cells with an agent, aratio of an amount of the agent and the number of CAR cells is 1:50 to1:5 (μg/104 cell), 1:500 to 1:5 (μg/104 cell), or 1:5000 to 10:5 (μg/104cell). In some embodiments, culturing the cells comprises culturing thecells using a culture medium comprising at least one of anti-CD3 beads,anti-CD28 beads, and IL2. In some embodiments, after culturing the CARcells with an agent, a ratio of an amount of the agent and the number ofCAR cells is 1:50 to 1:5 (μg/104 cell). In some embodiments, the numberof copies of CAR on the CAR cells cultured in the presence of the agentis greater than the number when the CAR cells are cultured without theagent. In some embodiments, a ratio of the number of cells expressingthe CAR and the number of cells not expressing the CAR when cultured inthe presence of the agent is greater than the ratio when the cells arecultured without the agent. In some embodiments, culturing the CAR cellsin the presence of the agent comprises: culturing the CAR cells in thepresence of the agent for a predetermined period of time, or culturingthe CAR cells in the presence of the agent for at least 10, 11, 12, 13,14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30days. In some embodiments, the predetermined period of time is from7-100 days. In some embodiments, the number of the CAR cells producing aphenotype of memory T cells, when cultured in the presence of an agentis greater than the number when the CAR cells are cultured without theagent. In some embodiments, the amount of a cytokine produced by the CARcells, when cultured in the presence of the agent, is greater than theamount of the cytokine produced by CAR cells when the CAR cells arecultured without the agent.

In some embodiments, the CAR cells are derived from a healthy donor andhave a reduced expression of endogenous TCR gene and/or HLA I. In someembodiments, the CAR cells are derived from a healthy donor and elicitno graft-versus-host disease (GVHD) response or a reduced GVHD responsein a human recipient as compared to the GVHD response elicited by aprimary human T-cell isolated from the same human donor and having noreduced expression of the endogenous TCR gene and/or HLA I, or that theexpression of the endogenous TCR gene and/or HLA I is not disrupted andthe endogenous TCR gene and/or HLA I are expressed as normal. In someembodiments, the CAR T cell is a T cell comprising a nucleic acidsequence encoding hTERT, a nucleic acid encoding SV40LT, or acombination thereof.

In some embodiments, the CAR cells comprise a nucleic acid sequenceencoding hTERT and a nucleic acid encoding SV40LT. In some embodiments,expression of hTERT is regulated by an inducible expression system. Insome embodiments, expression of SV40LT gene is regulated by an inducibleexpression system. In some embodiments, the inducible expression systemis rtTA-TRE, which increases or activates the expression of the SV40LTgene, the hTERT gene, or a combination thereof. In some embodiments, theCAR cell comprises a nucleic acid sequence encoding a suicide gene. Insome embodiments, the suicide gene is an HSV-TK system.

Some embodiments relate to an isolated cell obtained by the methodabove.

Some embodiments relate to a pharmaceutical composition comprising theisolated cells obtained by the method above.

Some embodiments relate to a method for stimulating an anti-tumor immuneresponse in a subject, the method comprising administering to a subjectin need thereof an effective amount of the pharmaceutical composition.Some embodiments relate to a pharmaceutical composition for use in thetreatment of cancer comprising administering to a subject in needthereof, an effective amount of the pharmaceutical composition. In someembodiments, a spacer domain of the CAR comprises an amino acid sequenceof SEQ ID NO.: 68 or 69. In some embodiments, a transmembrane domain ofthe CAR comprises an amino acid sequence of SEQ ID NO.: 72 or 75 and aspacer domain of the CAR comprises an amino acid sequence of SEQ ID NO.:68.

Some embodiments relate to a method comprising: administering aneffective amount of T cells comprising a CAR to the subject in needthereof to provide a T cell response, and administering an effectiveamount of presenting cells expressing a soluble agent that theextracellular domain of the CAR recognizes.

Some embodiments relate to a method of enhancing T cell response in asubject, the method comprising: administering an effective amount of Tcell comprising a CAR to the subject to provide a T cell response; andadministering an effective amount of presenting cells expressing asoluble agent that an extracellular domain of the CAR recognizes toenhance the T cell response in the subject. In some embodiments, theenhancing T cell response in the subject comprises selectively enhancingproliferation of T cells comprising the CAR.

Some embodiments relate to a method of enhancing treatment of acondition of a subject using CAR cells. In some embodiments, the methodcomprises administrating to the subject a population of cells thatexpress an agent and a population of CAR cells. In other embodiments,the method comprises administering to the subject a vaccine derived fromthe agent and a population of CAR cells. The CAR cells comprise anucleic acid sequence that encodes a CAR, and an extracellular domain ofthe CAR recognizes the agent.

Some embodiments relate to a method of enhancing proliferation of CARcells in a subject having a disease. The method comprises: preparingcells comprising a CAR; administering an effective amount of the CARcells to the subject; introducing into cells, a nucleic acid sequenceencoding an agent that an extracellular domain of the CAR recognizes toobtain modified cells, and administering an effective amount of themodified cells to the subject.

In some embodiments, the agent is a ligand for the extracellular domainof the CAR. In some embodiments, the agent is an antigen that theextracellular domain of the CAR binds, and the agent comprises anextracellular domain of at least one of Epidermal growth factor receptor(EGFR), Variant III of the epidermal growth factor receptor (EGFRvIII),Human epidermal growth factor receptor 2 (HER2), Mesothelin (MSLN),Prostate-specific membrane antigen (PSMA), Carcinoembryonic antigen(CEA), Disialoganglioside 2 (GD2), Interleukin-13Ra2 (IL13Rα2),Glypican-3 (GPC3), Carbonic anhydrase IX (CAIX), L1 cell adhesionmolecule (L1-CAM), Cancer antigen 125 (CA125), Cluster ofdifferentiation 133 (CD133), Fibroblast activation protein (FAP),Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folate receptor-α(FR-(α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, orCD4. In some embodiments, the agent comprises at least one of amino acidsequences: SEQ IDs: 41-47 and 61-63. In some embodiments, the agentbinds at least one of amino acid sequences: SEQ IDs: 55, 21, 48, 49, 40,51-53, and 56-60. In some embodiments, the agent comprises at least oneof GCC, B7-H4, Prostate specific membrane antigen (PSMA),Carcinoembryonic Antigen (CEA), IL13Ralpha, her-2, CD19, CD20, CD22,CD123, NY-ESO-1, HIV-I Gag, Lewis Y, Mart-I, gplOO, tyrosinase, WT-I, hTERI, MUC16, mesothelin, MIC-A, MIC-B, estrogen, progesterone, RON, orone or more members of the ULBP/RAETI family. In some embodiments, thecostimulatory molecule of CAR comprises at least one of CD27, CD28,4-IBB, OX40, CD30, CD40, PD-L ICOS, lymphocyte function-associatedantigen-I (LFA-1), CD2, CD7, LIGHT, NKG2C, or B7-H3. In someembodiments, the CAR comprises the extracellular domain, a transmembranedomain, and an intracellular domain comprising a CD3-zeta signalingdomain and a signaling domain of a costimulatory molecule. In someembodiments, the agent is expressed by the cells, and the expression ofthe agent is regulated by an inducible expression system. In someembodiments, the CAR cells are cultured with cells that express theagent, and the agent is expressed by the cells, and the expression ofthe agent is regulated by an inducible suicide gene expression system.In some embodiments, the cells are modified cells that have reducedimmunogenicity for an allogeneic CAR therapy, as compared to a wild-typecell. In some embodiments, the agent is a soluble antigen such that theantigen is released by the cells that express the agent. In someembodiments, the cells that express the agent are attenuated to beviable and replication incompetent. In some embodiments, the cells thatexpress the agent are attenuated to be viable and replicationincompetent by gamma irradiation or chemical inactivation. In someembodiments, the cells that express the agent or the isolated modifiedcells are obtained from peripheral blood mononuclear cells (PBMC) of thesubject. In some embodiments, the cells that express the agent are Tcells of the subject. In some embodiments, the cells that express theagent are T cells that are formulated as a vaccine. In some embodiments,the cells that express the agent are attenuated tumor cells. In someembodiments, a spacer domain of the CAR comprises an amino acid sequenceof SEQ ID NO.: 68 or 69. In some embodiments, the transmembrane domainof the CAR comprises an amino acid sequence of SEQ ID NO.: 72 or 75, andthe spacer domain of the CAR comprises an amino acid sequence of SEQ IDNO.: 68.

Some embodiments relate to an isolated nucleic acid sequence encoding aCAR comprising an extracellular domain, a spacer domain, a transmembranedomain, and an intracellular domain. The extracellular domain of the CARbinds a tumor antigen, and the spacer domain comprises an amino acidsequence of SEQ ID NO.: 67 or 68.

Some embodiments relate to an isolated nucleic acid sequence encoding aCAR comprising an extracellular domain, a spacer domain, a transmembranedomain, and an intracellular domain. The extracellular domain of the CARbinds a tumor antigen; the spacer domain comprises an amino acidsequence of SEQ ID NO.: 69; and the transmembrane domain comprises anamino acid sequence of SEQ ID NO.: 73 or 74.

In some embodiments, the antigen binding domain of the CAR comprises anantibody, a ligand, or an antigen-binding fragment thereof. In someembodiments, the antigen-binding fragment comprises a Fab or a scFv. Insome embodiments, the tumor antigen includes HER2, CD19, CD20, CD22,Kappa or light chain, CD30, CD33, CD123, CD38, ROR1, ErbB3/4, EGFR,EGFRvIII, EphA2, FAP, carcinoembryonic antigen, EGP2, EGP40, mesothelin,TAG72, PSMA, NKG2D ligands, B7-H6, IL-13 receptor α 2, IL-11 receptor α,MUC1, MUC16, CA9, GD2, GD3, HMW-MAA, CD171, Lewis Y, G250/CAIX, HLA-AIMAGE A1, HLA-A2 NY-ESO-1, PSC1, folate receptor-α, CD44v7/8, 8H9, NCAM,VEGF receptors, 5T4, Fetal AchR, NKG2D ligands, CD44v6, TEM1, or TEM8.In some embodiments, the intracellular domain of the CAR comprises acostimulatory signaling domain that includes an intracellular domain ofa costimulatory molecule selected from the group consisting of CD27,CD28, 4-1BB, OX40, CD30, CD40, PD-1, ICOS, lymphocytefunction-associated antigen-1 (LFA-1), CD2, CD7, LIGHT, NKG2C, B7-H3,and any combination thereof. In some embodiments, the intracellulardomain of the CAR comprises a CD3 zeta signaling domain.

Some embodiments relate to a vector comprising the isolated nucleic acidsequence described above.

Some embodiments relate to a cell comprising the isolated nucleic acidsequence described above.

Some embodiments relate to a composition comprising a population of Tcells which comprises the isolated nucleic acid sequence describedabove.

Some embodiments relate to a method for stimulating an anti-tumor immuneresponse or treating a condition in a subject. The method comprisesadministrating to the subject an effective amount of a pharmaceuticalcomposition comprising a population of human T cells which comprises theisolated nucleic acid sequence described above.

Some embodiments relate to a method comprising: providing cellscomprising the isolated nucleic acid sequence described above andculturing the cells in the presence of an agent that the extracellulardomain of the CAR recognizes.

Some embodiments relate to a method for in vitro CAR cell preparation.The method comprises: providing cells; introducing any one of theisolated nucleic acid sequence described above into the cells to obtainCAR cells; and culturing the CAR cells in the presence of an agent thatthe extracellular domain of the CAR recognizes.

Some embodiments relate to a method for enriching cells expressing aCAR. The method comprises: providing cells; introducing any one of theisolated nucleic acid sequence described above into the cells to obtaincells expressing a CAR (CAR cells) and cells that do not express theCAR; and culturing the CAR cells in the presence of an agent that bindsthe extracellular domain of the CAR to enrich the cells expressing theCAR.

In some embodiments, the agent is a ligand for the extracellular domainof the CAR. In some embodiments, the agent is an antigen that theextracellular domain of the CAR binds. In some embodiments, the agent isthe extracellular domain of an antigen. In some embodiments, the antigenis Epidermal growth factor receptor (EGFR), Variant III of the epidermalgrowth factor receptor (EGFRvIII), Human epidermal growth factorreceptor 2 (HER2), Mesothelin (MSLN), Prostate-specific membrane antigen(PSMA), Carcinoembryonic antigen (CEA), Disialoganglioside 2 (GD2),Interleukin-13Ra2 (IL13Rα2), Glypican-3 (GPC3), Carbonic anhydrase IX(CAIX), L1 cell adhesion molecule (L1-CAM), Cancer antigen 125 (CA125),Cluster of differentiation 133 (CD133), Fibroblast activation protein(FAP), Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folatereceptor-α (FR-α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3,CD5, or CD4. In some embodiments, the agent is an antibody that bindsthe extracellular domain of the CAR. In some embodiments, the antibodyis a human IgG antibody. In some embodiments, the antibody binds a Fabfragment of a human IgG. In some embodiments, the agent comprises anextracellular domain of at least one of CD19, FZD10, TSHR, PRLR, Muc 17,GUCY2C, CD207, CD3, CD5, or CD4. In some embodiments, the agentcomprises at least one of amino acid sequences: SEQ IDs: 22 and 34. Insome embodiments, the agent binds at least one of amino acid sequences:SEQ IDs: 55, 21, 48, 49, 40, and 50-60. In some embodiments, the agentactivates the CAR and/or causes a co-stimulatory response of the cells.In some embodiments, the cells that express the antigen are an NK cellor a T cell, or a combination thereof.

This Summary is not intended to identify key features or essentialfeatures of the claimed subject matter, nor is it intended to be used tolimit the scope of the claimed subject matter.

BRIEF DESCRIPTION OF THE DRAWINGS

The Detailed Description is described with reference to the accompanyingfigures. The use of the same reference numbers in different figuresindicates similar or identical items.

FIG. 1 shows a schematic diagram illustrating culturing T cells with orwithout an antigen and a histogram showing results of cell expansion ofnon-transduced T cells and CAR T cells using a media without an agent inaccordance with the embodiments of the present disclosure.

FIG. 2 shows a table with various parameters for comparison of T cellscultured with or without an antigen.

FIG. 3 shows the results of flow cytometry analysis indicating CD19maintains CAR T 19 cells activities.

FIG. 4 shows the results of flow cytometry analysis indicating CD19stimulates and/or induces CAR T cells to produce the phenotype of memorycells.

FIG. 5 shows the results of flow cytometry analysis indicating CD19stimulates and/or induces CAR T cells to produce the phenotype of memorycells. The analysis results indicate that CD19 stabilizes the state ofcells. 402 and 406 of FIG. 4 indicate levels of cell debris of cellscultured with and without CD19, respectively. 404 and 408 of FIG. 4indicate proportions of cell debris with respect to the cells culturedwith and without CD19, respectively.

FIG. 6 shows histograms indicating CD19 enhances capability of releasingIFN gamma.

FIG. 7 shows the results of flow cytometry analysis indicating CD19maintains the presence of CAR T cells.

FIG. 8 shows the results of flow cytometry analysis indicating TSHRmaintains CAR T-TSHR cells activities.

FIG. 9 shows ΔMFI (median fluorescence intensity) of CART-TSHR cells.MFI refers to the median fluorescence of the population of cells and iscalculated as a numerical value.

FIG. 10 shows additional results of flow cytometry analysis indicatingTSHR maintains CAR T-TSHR cells activities

FIG. 11 shows cellular morphology of CAR T-TSHR cells cultured with andwithout TSHR.

FIG. 12 shows a schematic diagram of the structures of an exemplary CARmolecule and a portion of the cell membrane.

FIG. 13 shows various constructs of CARs and expansion results of Tcells having the CARs. T cells with various contracts of CARs werecultured for a predetermined time, respectively. Flow cytometricanalysis of the cultured T cells was performed on day 1 and day 15; cellexpansion ratios were measured. A histogram is showing expansion foldsof CAR T cells cultured with or without CD19 extracellular domain.

FIG. 14 shows flow cytometric analysis of CAR T cell expansion in thefour groups, as indicated in FIG. 13. The CAR T cells were culturedwithout CD19 extracellular domain for 15 days.

FIG. 15 shows flow cytometric analysis of CAR T cell expansion in thefour groups, as indicated in FIG. 13. The CAR T cells were cultured withCD19 extracellular domain for 15 days.

FIG. 16 shows flow cytometric analysis of CAR expression levels on CAR Tcells in the four groups, as indicated in FIG. 13. The CAR T cells werecultured without CD19 extracellular domain for 15 days.

FIG. 17 shows flow cytometric analysis of CAR expression level on CAR Tcells in the four groups, as indicated in FIG. 13. The CAR T cells werecultured with CD19 extracellular domain for 20 days.

FIG. 18 shows flow cytometric analysis of CD4/CD8 phenotypic changes inCAR T cells.

FIG. 19 shows flow cytometric analysis of CD4/CD8 phenotypic changes inCAR T cells.

FIG. 20 shows flow cytometric analysis of CAR expression levels on CAR Tcells in two groups, as indicated in FIG. 13. The CAR T cells werecultured CD19 extracellular domain for 17 days.

FIG. 21 shows flow cytometric analysis of a killing assay on CAR Tcells.

FIG. 22 shows flow cytometric analysis of IFN-g release of CAR T cells.

FIG. 23 shows schematic diagrams for a plurality of DNA constructs.

FIG. 24 shows fluorescence photographs of the killing effect of T cells.

FIG. 25 shows fluorescence photographs of the killing effect of T cells.

FIG. 26 shows fluorescence photographs of the killing effect of T cells.

FIG. 27 shows a graph of multiple immortalized single-cell sequencingassays.

FIG. 28 shows a graph of multiple immortalized single-cell sequencingassays.

FIG. 29 shows a graph of multiple immortalized single-cell sequencingassays.

FIG. 30 shows a graph of multiple immortalized single-cell sequencingassays.

FIG. 31 shows a graph of multiple immortalized single-cell sequencingassays.

FIG. 32 shows flow cytometry results of CAR expression in immortalized Tcells. The two ordinates in the above figures represent the expressionof CAR. The abscissa is the expression of CD279 (PD1). The left isIsotype Control, and the right is the CAR antibody. A vector includingDNA of ef1a-TK-IRES-rtTa-TRE-hTERT and a vector including DNA encodinghCD19 CAR were used to infect T cells. During the culturing, CD19peptide was added to stimulate the growth of T cells. It can be seenthat the expression of cell CAR 82.87%. Qualitative+quantitativeresults. The lower table shows the copy number experiment of CAR. It canbe seen that there are 2241151 copies of CAR per 1 ug of gDNA in CAR Tcells that induce expression of hCD19 in the expression system, which isa quantitative result. “dt mix” refers to a control group includingcells that were merely transduced with ef1a-TK-IRES-rtTA-TRE-hTERTwithout DAN encoding anti-CD19 CAR.

FIG. 33 shows a graph indicating that the cells are dual-switch T cellCD8+monoclonal cells (Dox concentration at 2 ug/ML). rTetR was used inthe construction of anti-CD19 CAR proliferable T cells. Therefore, hTERTwas expressed when doxycycline (Dox) was added to the culture. When Doxwas not added, hTERT was not expressed, and the cells gradually began todie.

FIG. 34 shows a graph indicating dual-safety-T/CAR T cell 1+/−TK(ganciclovir).

FIG. 35 shows results of flow cytometry analysis indicatingdual-safety-T/CAR T cell 1+/−TK (ganciclovir).

FIG. 36 shows results of flow cytometry analysis indicatingdual-safety-T/CAR T cell 1+/−TK (ganciclovir). Experimental cells:CD8+CZY-1 SDS-T and NT cell; TK usage: Adult body concentration of 71.45ng/ml/5000 ng/kg every 24 h injection. In vitro experimentalconcentration gradients: 357.2 ng/ml, 142.9 ng/ml, 71.45 ng/ml, 35.725ng/ml, 14.28 ng/ml, 3.6 ng/ml. As an example, FIG. 36 shows that 35.725ng/ml was used in the control and the experiment. The starting cellswere cultured in 200 w cell density of 50 w/ml.

FIG. 37 shows concentration gradient culture function test showingCD8+dual-switch-CAR T cell.

FIG. 38 shows optimum culture concentration: 50 w/ml to 100 w/ml, andLow or high concentrations can inhibit the growth of Dual-Switch Tcells. W/ml refers to 10 thousand per ml.

FIG. 39 shows dual-switch CART cell killing assay results.

FIG. 40 shows the results of cell killing analysis.

FIG. 41 shows the result of cells killing analysis. FIGS. 26 and 27 areresults of killing analysis (knock out the result of cd3 of primary tcell). After knocking out and transfecting CAR and hTERT, a universalCAR T was made. The flow chart: 32.17% of the left is cd3 knock cd3-celland 79.16% too. The sequencing peak map can be seen from the obvious setof peaks to prove the knocked out.

FIG. 42 shows CD3 negative cells obtained using ZFN and purified withCD3 microbeads. After purification, CD3 negative cells were seeded withAPC-CD3 antibody, and the results of the flow cytometry showed that theknockout was successful and 99.7% of the cells are CD3−. Then, these CD3negative cells were transfected with lentiviral copies of thedual-switch-hTERT and CAR into the genomes of these cells.

FIG. 43 shows survival and growth of various CAR T Cells. In Group 1(hTert CD19 CAR), the primary T cells obtained from a healthy donor weretransduced with a nucleic acid sequence encoding a CD19 CAR and anucleic acid sequence encoding hTERT. In Group 2 (CD19 CAR), the primaryT cells were transduced with the nucleic acid sequence encoding a CD19CAR. CAR T cells comprising the nucleic acid sequence encoding hTERTshow long-term survival. Among these CAR T cells, cells cultured using acell medium containing CD19 ECD exhibit higher cell growth rates thanthose cultured using a cell medium containing no CD19 ECD. CAR T cellsare not comprising the nucleic acid sequence encoding hTERT begun to dieafter about 20 days after cells were transduced with the nucleic acidsequence encoding CAR.

FIG. 44 shows cell growth of various groups of CAR T cells in differentconditions. A: Group 1 (hTERT+DOX+CD19): proliferable CD19 CAR T cells(hTERT) were cultured in a media containing ECD CD19 and Dox. Group 2(hTERT+DOX): proliferable CD19 CAR T cells (hTERT) were cultured in amedia containing Dox without ECD CD19. Group 3 (no hTERT CD19CAR-T):CD19 CAR Tcells were cultured in a media without Dox and ECD CD19. B:Group 1: CD19 CAR Tcells (h19CAR) were cultured in a media withoutcontaining ECD CD19 and Dox. Group 2: proliferable CD19 CAR T cells withdual-switch (dual-switch h19CAR+dox) were cultured in a media containingDox but no ECD CD19. Group 3: proliferable CD19 CAR T cells withdual-switch (dual-switch h19CAR+dox+cd19) were cultured in a mediacontaining Dox and ECD CD19. These results demonstrate that the agentand/or the prolifeable modification contribute long term maintenance ofCAR T cells in vitro.

FIG. 45 shows flow cytometry analysis indicating expression of anti-TSHRCAR molecules on T cells (Gated by a single live cell). Anti-TSHR CAR Tcells were constructed, and the expression of CAR molecules was detectedby flow cytometry. Compared to non-transduced T cells, expression of CARmolecules was observed.

FIG. 46 shows flow cytometry analysis indicating overexpression of TSHRon T cells (Gated by a single live cell). Lentiviral vectors were usedto construct antigen over-expressed T cells (TSHR). The expression ofTSHR molecules on the surface of T cells was observed (IgG on the leftand anti-TSHR FITC on the right).

FIG. 47 shows cytokine release (IL-2) in mouse peripheral blood.

FIG. 48 shows cytokine release (IFN-gamma) in mouse peripheral blood.

FIG. 49 shows cytokine release (IL-4) in mouse peripheral blood.

FIG. 50 shows CAR/CD3 positive cell rates in mouse peripheral blood.

FIG. 51 shows CAR T cells in mouse spleen 28 days after CAR T infusion.

DETAILED DESCRIPTION

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by those of ordinary skillin the art to which the disclosure belongs. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present disclosure, preferred methods andmaterials are described. For the purposes of the present disclosure, thefollowing terms are defined below.

The articles “a” and “an” are used herein to refer to one or to morethan one (i.e., to at least one) of the grammatical object of thearticle. By way of example, “an element” means one element or more thanone element.

By “about” is meant a quantity, level, value, number, frequency,percentage, dimension, size, amount, weight or length that varies by asmuch as 20, 15, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1% to a referencequantity, level, value, number, frequency, percentage, dimension, size,amount, weight or length.

The term “activation,” as used herein, refers to the state of a cellthat has been sufficiently stimulated to induce detectable cellularproliferation. Activation can also be associated with induced cytokineproduction and detectable effector functions. The term “activated Tcells” refers to, among other things, T cells that are undergoing celldivision.

The term “antibody” is used in the broadest sense and refers tomonoclonal antibodies (including full length monoclonal antibodies),polyclonal antibodies, multi-specific antibodies (e.g., bispecificantibodies), and antibody fragments so long as they exhibit the desiredbiological activity or function. The antibodies in the presentdisclosure may exist in a variety of forms including, for example,polyclonal antibodies, monoclonal antibodies, Fv, Fab and F(ab)2, aswell as single chain antibodies and humanized antibodies (Harlow et al.,1999, In: Using Antibodies: A Laboratory Manual, Cold Spring HarborLaboratory Press, NY; Harlow et al., 1989, In: Antibodies: A LaboratoryManual, Cold Spring Harbor, N.Y.; Houston et al., 1988, Proc. Natl.Acad. Sci. USA 85:5879-5883; Bird et al., 1988, Science 242:423-426).

The term “antibody fragments” refers to a portion of a full lengthantibody, for example, the antigen binding or variable region of theantibody. Other examples of antibody fragments include Fab, Fab′,F(ab′)2, and Fv fragments; diabodies; linear antibodies; single-chainantibody molecules; and multi-specific antibodies formed from antibodyfragments.

The term “Fv” refers to the minimum antibody fragment which contains acomplete antigen-recognition and -binding site. This fragment consistsof a dimer of one heavy- and one light-chain variable region domain intight, non-covalent association. From the folding of these two domainsemanates six hypervariable loops (3 loops each from the H and L chain)that contribute the amino acid residues for antigen binding and conferantigen binding specificity to the antibody. However, even a singlevariable domain (or half of an Fv including only three complementaritydetermining regions (CDRs) specific for an antigen) has the ability torecognize and bind antigen, although at a lower affinity than the entirebinding site (the dimer).

An “antibody heavy chain,” as used herein, refers to the larger of thetwo types of polypeptide chains present in all antibody molecules intheir naturally occurring conformations. An “antibody light chain,” asused herein, refers to the smaller of the two types of polypeptidechains present in all antibody molecules in their naturally occurringconformations. K and A light chains refer to the two major antibodylight chain isotypes.

The term “synthetic antibody” refers to an antibody which is generatedusing recombinant DNA technology, such as, for example, an antibodyexpressed by a bacteriophage. The term also includes an antibody whichhas been generated by the synthesis of a DNA molecule encoding theantibody and the expression of the DNA molecule to obtain the antibody,or to obtain an amino acid encoding the antibody. The synthetic DNA isobtained using technology that is available and well known in the art.

The term “antigen” refers to a molecule that provokes an immuneresponse, which may involve either antibody production, or theactivation of specific immunologically-competent cells, or both.Antigens include any macromolecule, including all proteins or peptides,or molecules derived from recombinant or genomic DNA. For example, DNAincluding a nucleotide sequence or a partial nucleotide sequenceencoding a protein or peptide that elicits an immune response, andtherefore, encodes an “antigen” as the term is used herein. An antigenneed not be encoded solely by a full-length nucleotide sequence of agene. An antigen can be generated, synthesized or derived from abiological sample including a tissue sample, a tumor sample, a cell, ora biological fluid.

The term “anti-tumor effect” as used herein, refers to a biologicaleffect associated with a decrease in tumor volume, a decrease in thenumber of tumor cells, a decrease in the number of metastases, decreasein tumor cell proliferation, decrease in tumor cell survival, anincrease in life expectancy of a subject having tumor cells, oramelioration of various physiological symptoms associated with thecancerous condition. An “anti-tumor effect” can also be manifested bythe ability of the peptides, polynucleotides, cells, and antibodies inthe prevention of the occurrence of tumor in the first place.

The term “auto-antigen” refers to an antigen mistakenly recognized bythe immune system as being foreign. Auto-antigens include cellularproteins, phosphoproteins, cellular surface proteins, cellular lipids,nucleic acids, glycoproteins, including cell surface receptors.

The term “autologous” is used to describe a material derived from asubject which is subsequently re-introduced into the same subject.

The term “allogeneic” is used to describe a graft derived from adifferent subject of the same species. As an example, a donor subjectmay be a related or unrelated or recipient subject, but the donorsubject has immune system markers which are similar to the recipientsubject.

The term “xenogeneic” is used to describe a graft derived from a subjectof a different species. As an example, the donor subject is from adifferent species than a recipient subject, and the donor subject andthe recipient subject can be genetically and immunologicallyincompatible.

The term “cancer” as used to refer to a disease characterized by therapid and uncontrolled growth of aberrant cells. Cancer cells can spreadlocally or through the bloodstream and lymphatic system to other partsof the body. Examples of various cancers include breast cancer, prostatecancer, ovarian cancer, cervical cancer, skin cancer, pancreatic cancer,colorectal cancer, renal cancer, liver cancer, brain cancer, lymphoma,leukemia, lung cancer, and the like.

Throughout this specification, unless the context requires otherwise,the words “comprise,” “includes” and “including” will be understood toimply the inclusion of a stated step or element or group of steps orelements but not the exclusion of any other step or element or group ofsteps or elements.

The phrase “consisting of” is meant to include, and is limited to,whatever follows the phrase “consisting of.” Thus, the phrase“consisting of” indicates that the listed elements are required ormandatory and that no other elements may be present.

The phrase “consisting essentially of” is meant to include any elementslisted after the phrase and can include other elements that do notinterfere with or contribute to the activity or action specified in thedisclosure for the listed elements. Thus, the phrase “consistingessentially of” indicates that the listed elements are required ormandatory, but that other elements are optional and may or may not bepresent depending upon whether or not they affect the activity or actionof the listed elements.

The terms “complementary” and “complementarity” refer to polynucleotides(i.e., a sequence of nucleotides) related by the base-pairing rules. Forexample, the sequence “A-G-T,” is complementary to the sequence “T-C-A.”Complementarity may be “partial,” in which only some of the nucleicacids' bases are matched according to the base pairing rules. Or, theremay be “complete” or “total” complementarity between the nucleic acids.The degree of complementarity between nucleic acid strands hassignificant effects on the efficiency and strength of hybridizationbetween nucleic acid strands.

The term “corresponds to” or “corresponding to” refers to (a) apolynucleotide having a nucleotide sequence that is substantiallyidentical or complementary to all or a portion of a referencepolynucleotide sequence or encoding an amino acid sequence identical toan amino acid sequence in a peptide or protein; or (b) a peptide orpolypeptide having an amino acid sequence that is substantiallyidentical to a sequence of amino acids in a reference peptide orprotein.

The term “co-stimulatory ligand,” refers to a molecule on an antigenpresenting cell (e.g., an APC, dendritic cell, B cell, and the like)that specifically binds a cognate co-stimulatory molecule on a T cell,thereby providing a signal which, in addition to the primary signalprovided by, for instance, binding of a TCR/CD3 complex with an MHCmolecule loaded with peptide, mediates a T cell response, including atleast one of proliferation, activation, differentiation, and othercellular responses. A co-stimulatory ligand can include B7-1 (CD80),B7-2 (CD86), PD-L1, PD-L2, 4-1BBL, OX40L, inducible co-stimulatoryligand (ICOS-L), intercellular adhesion molecule (ICAM), CD30L, CD40,CD70, CD83, HLA-G, MICA, MICB, HVEM, lymphotoxin beta receptor, 3/TR6,ILT3, ILT4, HVEM, a ligand for CD7, an agonist or antibody that bindsthe Toll ligand receptor and a ligand that specifically binds withB7-H3. A co-stimulatory ligand also includes, inter alia, an agonist oran antibody that specifically binds with a co-stimulatory moleculepresent on a T cell, such as CD27, CD28, 4-1BB, OX40, CD30, CD40, PD-1,ICOS, lymphocyte function-associated antigen-1 (LFA-1), CD2, CD7, LIGHT,NKG2C, B7-H3, and a ligand that specifically binds CD83.

The term “co-stimulatory molecule” refers to the cognate binding partneron a T cell that specifically binds with a co-stimulatory ligand,thereby mediating a co-stimulatory response by the T cell, such asproliferation. Co-stimulatory molecules include an MHC class I molecule,BTLA, and a Toll-like receptor.

The term “co-stimulatory signal” refers to a signal, which incombination with a primary signal, such as TCR/CD3 ligation, leads to Tcell proliferation and/or upregulation or downregulation of keymolecules. The terms “disease” and “condition” may be usedinterchangeably or may be different in that the particular malady orcondition may not have a known causative agent (so that etiology has notyet been worked out), and it is therefore not yet recognized as adisease but only as an undesirable condition or syndrome, wherein a moreor less specific set of symptoms have been identified by clinicians. Theterm “disease” is a state of health of a subject wherein the subjectcannot maintain homeostasis, and wherein if the disease is notameliorated then the subject's health continues to deteriorate. Incontrast, a “disorder” in a subject is a state of health in which theanimal is able to maintain homeostasis, but in which the animal's stateof health is less favorable than it would be in the absence of thedisorder. Left untreated, a disorder does not necessarily cause afurther decrease in the animal's state of health.

The term “effective” refers to adequate to accomplish a desired,expected, or intended result. For example, an “effective amount” in thecontext of treatment may be an amount of a compound sufficient toproduce a therapeutic or prophylactic benefit.

The term “encoding” refers to the inherent property of specificsequences of nucleotides in a polynucleotide, such as a gene, a cDNA, oran mRNA, to serve as templates for synthesis of other polymers andmacromolecules in biological processes having either a defined sequenceof nucleotides (i.e., rRNA, tRNA and mRNA) or a defined sequence ofamino acids and the biological properties resulting therefrom. Thus, agene encodes a protein if transcription and translation of mRNAcorresponding to that gene produces the protein in a cell or otherbiological system. Both the coding strand, the nucleotide sequence ofwhich is identical to the mRNA sequence (except that a “T” is replacedby a “U”) and is usually provided in sequence listings, and thenon-coding strand, used as the template for transcription of a gene orcDNA, can be referred to as encoding the protein or other product ofthat gene or cDNA.

The term “exogenous” refers to a molecule that does not naturally occurin a wild-type cell or organism but is typically introduced into thecell by molecular biological techniques. Examples of exogenouspolynucleotides include vectors, plasmids, and/or man-made nucleic acidconstructs encoding the desired protein. With regard to polynucleotidesand proteins, the term “endogenous” or “native” refers to anaturally-occurring polynucleotide or amino acid sequences that may befound in a given wild-type cell or organism. Also, a particularpolynucleotide sequence that is isolated from a first organism andtransferred to a second organism by molecular biological techniques istypically considered an “exogenous” polynucleotide or amino acidsequence with respect to the second organism. In specific embodiments,polynucleotide sequences can be “introduced” by molecular biologicaltechniques into a microorganism that already contains such apolynucleotide sequence, for instance, to create one or more additionalcopies of an otherwise naturally-occurring polynucleotide sequence, andthereby facilitate overexpression of the encoded polypeptide.

The term “expression” refers to the transcription and/or translation ofa particular nucleotide sequence driven by its promoter.

The term “expression vector” refers to a vector including a recombinantpolynucleotide including expression control sequences operably linked toa nucleotide sequence to be expressed.

An expression vector includes sufficient cis-acting elements forexpression; other elements for expression can be supplied by the hostcell or in an in vitro expression system. Expression vectors include allthose known in the art, such as cosmids, plasmids (e.g., naked orcontained in liposomes) and viruses (e.g., lentiviruses, retroviruses,adenoviruses, and adeno-associated viruses) that incorporate therecombinant polynucleotide.

The term “homologous” refers to sequence similarity or sequence identitybetween two polypeptides or between two polynucleotides when a positionin both of the two compared sequences is occupied by the same base oramino acid monomer subunit, e.g., if a position in each of two DNAmolecules is occupied by adenine, then the molecules are homologous atthat position. The percent of homology between two sequences is afunction of the number of matching or homologous positions shared by thetwo sequences divided by the number of positions compared ×100. Forexample, if 6 of 10 of the positions in two sequences are matched orhomologous, then the two sequences are 60% homologous. By way ofexample, the DNA sequences ATTGCC and TATGGC share 50% homology. Acomparison is made when two sequences are aligned to give maximumhomology.

The term “immunoglobulin” or “Ig,” refers to a class of proteins, whichfunction as antibodies. The five members included in this class ofproteins are IgA, IgG, IgM, IgD, and IgE. IgA is the primary antibodythat is present in body secretions, such as saliva, tears, breast milk,gastrointestinal secretions and mucus secretions of the respiratory andgenitourinary tracts. IgG is the most common circulating antibody. IgMis the main immunoglobulin produced in the primary immune response inmost subjects. It is the most efficient immunoglobulin in agglutination,complement fixation, and other antibody responses, and is important indefense against bacteria and viruses. IgD is the immunoglobulin that hasno known antibody function but may serve as an antigen receptor. IgE isthe immunoglobulin that mediates immediate hypersensitivity by causingthe release of mediators from mast cells and basophils upon exposure tothe allergen.

The term “isolated” refers to a material that is substantially oressentially free from components that normally accompany it in itsnative state. The material can be a cell or a macromolecule such as aprotein or nucleic acid. For example, an “isolated polynucleotide,” asused herein, refers to a polynucleotide, which has been purified fromthe sequences which flank it in a naturally-occurring state, e.g., a DNAfragment which has been removed from the sequences that are normallyadjacent to the fragment. Alternatively, an “isolated peptide” or an“isolated polypeptide” and the like, as used herein, refer to in vitroisolation and/or purification of a peptide or polypeptide molecule fromits natural cellular environment, and from association with othercomponents of the cell.

The term “substantially purified” refers to a material that issubstantially frr from components that normally associated with it inits native state. For example, a substantially purified cell refers to acell that has been separated from other cell types with which it isnormally associated in its naturally occurring or native state. In someinstances, a population of substantially purified cells refers to ahomogenous population of cells. In other instances, this term referssimply to a cell that has been separated from the cells with which theyare naturally associated in their natural state. In some embodiments,the cells are cultured in vitro. In other embodiments, the cells are notcultured in vitro.

In the context of the present disclosure, the following abbreviationsfor the commonly occurring nucleic acid bases are used. “A” refers toadenosine, “C” refers to cytosine, “G” refers to guanosine, “T” refersto thymidine, and “U” refers to uridine.

Unless otherwise specified, a “nucleotide sequence encoding an aminoacid sequence” includes all nucleotide sequences that are degenerateversions of each other and that encode the same amino acid sequence. Thephrase nucleotide sequence that encodes a protein or an RNA may alsoinclude introns to the extent that the nucleotide sequence encoding theprotein may in some version contain an intron(s).

The term “lentivirus” refers to a genus of the Retroviridae family.Lentiviruses are unique among the retroviruses in being able to infectnon-dividing cells; they can deliver a significant amount of geneticinformation into the DNA of the host cell, so they are one of the mostefficient methods of a gene delivery vector. HIV, SIV, and FIV are allexamples of lentiviruses. Vectors derived from lentiviruses offer themeans to achieve significant levels of gene transfer in vivo.

The term “modulating,” refers to mediating a detectable increase ordecrease in the level of a response in a subject compared with the levelof a response in the subject in the absence of a treatment or compound,and/or compared with the level of a response in an otherwise identicalbut untreated subject. The term encompasses perturbing and/or affectinga native signal or response thereby mediating a beneficial therapeuticresponse in a subject, preferably, a human.

Nucleic acid is “operably linked” when it is placed into a functionalrelationship with another nucleic acid sequence. For example, DNA for apresequence or secretory leader is operably linked to DNA for apolypeptide if it is expressed as a preprotein that participates in thesecretion of the polypeptide; a promoter or enhancer is operably linkedto a coding sequence if it affects the transcription of the sequence; ora ribosome binding site is operably linked to a coding sequence if it ispositioned so as to facilitate translation.

The term “under transcriptional control” refers to a promoter beingoperably linked to and in the correct location and orientation inrelation to a polynucleotide to control the initiation of transcriptionby RNA polymerase and expression of the polynucleotide.

The term “overexpressed” tumor antigen or “overexpression” of the tumorantigen is intended to indicate an abnormal level of expression of thetumor antigen in a cell from a disease area such as a solid tumor withina specific tissue or organ of the patient relative to the level ofexpression in a normal cell from that tissue or organ. Patients havingsolid tumors or a hematological malignancy characterized byoverexpression of the tumor antigen can be determined by standard assaysknown in the art.

“Parenteral” administration of an immunogenic composition includes,e.g., subcutaneous (s.c.), intravenous (i.v.), intramuscular (i.m.),intrasternal injection, or infusion techniques.

The terms “patient,” “subject,” and “individual,” and the like are usedinterchangeably herein, and refer to any human, animal, or livingorganism, amenable to the methods described herein. In certainnon-limiting embodiments, the patient, subject, or individual is a humanor animal. In some embodiments, the term “subject” is intended toinclude living organisms in which an immune response can be elicited(e.g., mammals). Examples of subjects include humans, and animals suchas dogs, cats, mice, rats, and transgenic species thereof.

A subject in need of treatment or in need thereof includes a subjecthaving a disease, condition, or disorder that needs to be treated. Asubject in need thereof also includes a subject that needs treatment forprevention of a disease, condition, or disorder.

The term “polynucleotide” or “nucleic acid” refers to mRNA, RNA, cRNA,rRNA, cDNA or DNA. The term typically refers to a polymeric form ofnucleotides of at least 10 bases in length, either ribonucleotides ordeoxynucleotides or a modified form of either type of nucleotide. Theterm includes all forms of nucleic acids including single anddouble-stranded forms of nucleic acids.

The terms “polynucleotide variant” and “variant” and the like refer topolynucleotides displaying substantial sequence identity with areference polynucleotide sequence or polynucleotides that hybridize witha reference sequence under stringent conditions that are definedhereinafter. These terms also encompass polynucleotides that aredistinguished from a reference polynucleotide by the addition, deletionor substitution of at least one nucleotide. Accordingly, the terms“polynucleotide variant” and “variant” include polynucleotides in whichone or more nucleotides have been added or deleted or replaced withdifferent nucleotides. In this regard, it is well understood in the artthat certain alterations inclusive of mutations, additions, deletions,and substitutions can be made to a reference polynucleotide whereby thealtered polynucleotide retains the biological function or activity ofthe reference polynucleotide or has increased activity in relation tothe reference polynucleotide (i.e., optimized). Polynucleotide variantsinclude, for example, polynucleotides having at least 50% (and at least51% to at least 99% and all integer percentages in between, e.g., 90%,95%, or 98%) sequence identity with a reference polynucleotide sequencedescribed herein. The terms “polynucleotide variant” and “variant” alsoinclude naturally-occurring allelic variants and orthologs.

“Polypeptide,” “polypeptide fragment,” “peptide,” and “protein” are usedinterchangeably herein to refer to a polymer of amino acid residues andto variants and synthetic analogues of the same. Thus, these terms applyto amino acid polymers in which one or more amino acid residues aresynthetic non-naturally occurring amino acids, such as a chemicalanalogue of a corresponding naturally occurring amino acid, as well asto naturally-occurring amino acid polymers. In some embodiments,polypeptides may include enzymatic polypeptides, or “enzymes,” whichtypically catalyze (i.e., increase the rate of) various chemicalreactions.

The term “polypeptide variant” refers to polypeptides that aredistinguished from a reference polypeptide sequence by the addition,deletion, or substitution of at least one amino acid residue. In certainembodiments, a polypeptide variant is distinguished from a referencepolypeptide by one or more substitutions, which may be conservative ornon-conservative. In certain embodiments, the polypeptide variantcomprises conservative substitutions and, in this regard, it is wellunderstood in the art that some amino acids may be changed to otherswith broadly similar properties without changing the nature of theactivity of the polypeptide. Polypeptide variants also encompasspolypeptides in which one or more amino acids have been added or deletedor replaced with different amino acid residues.

The term “promoter” refers to a DNA sequence recognized by the syntheticmachinery of the cell or introduced synthetic machinery, required toinitiate the specific transcription of a polynucleotide sequence. Theterm “expression control sequences” refers to DNA sequences necessaryfor the expression of an operably linked coding sequence in a particularhost organism. The control sequences that are suitable for prokaryotes,for example, include a promoter, optionally an operator sequence, and aribosome binding site. Eukaryotic cells are known to utilize promoters,polyadenylation signals, and enhancers.

The term “bind,” “binds,” or “interacts with” refers to a moleculerecognizing and adhering to a particular second molecule in a sample ororganism but does not substantially recognize or adhere to otherstructurally unrelated molecules in the sample. The term “specificallybinds,” as used herein with respect to an antibody, refers to anantibody which recognizes a specific antigen, but does not substantiallyrecognize or bind other molecules in a sample. For example, an antibodythat specifically binds an antigen from one species may also bind thatantigen from one or more species. But, such cross-species reactivitydoes not itself alter the classification of an antibody as specific. Inanother example, an antibody that specifically binds an antigen may alsobind different allelic forms of the antigen. However, such crossreactivity does not itself alter the classification of an antibody asspecific. In some instances, the terms “specific binding” or“specifically binding,” can be used in reference to the interaction ofan antibody, a protein, or a peptide with a second chemical species, tomean that the interaction is dependent upon the presence of a particularstructure (e.g., an antigenic determinant or epitope) on the chemicalspecies; for example, an antibody recognizes and binds a specificprotein structure rather than to any protein. If an antibody is specificfor epitope “A,” the presence of a molecule containing epitope A (orfree, unlabeled A), in a reaction containing labeled “A” and theantibody, will reduce the amount of labeled A bound to the antibody.

By “statistically significant,” it is meant that the result was unlikelyto have occurred by chance. Statistical significance can be determinedby any method known in the art. Commonly used measures of significanceinclude the p-value, which is the frequency or probability with whichthe observed event would occur if the null hypothesis were true. If theobtained p-value is smaller than the significance level, then the nullhypothesis is rejected. In simple cases, the significance level isdefined at a p-value of 0.05 or less. A “decreased” or “reduced” or“lesser” amount is typically a “statistically significant” or aphysiologically significant amount, and may include a decrease that isabout 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 1.7, 1.8, 1.9, 2, 2.5, 3, 3.5, 4,4.5, 5, 6, 7, 8, 9, 10, 15, 20, 30, 40, or 50 or more times (e.g., 100,500, 1000 times) (including all integers and decimal points in betweenand above 1, e.g., 1.5, 1.6, 1.7. 1.8, etc.) an amount or leveldescribed herein.

The term “stimulation,” refers to a primary response induced by bindingof a stimulatory molecule (e.g., a TCR/CD3 complex) with its cognateligand thereby mediating a signal transduction event, such as signaltransduction via the TCR/CD3 complex. Stimulation can mediate alteredexpression of certain molecules, such as downregulation of TGF-β, and/orreorganization of cytoskeletal structures.

The term “stimulatory molecule” refers to a molecule on a T cell thatspecifically binds a cognate stimulatory ligand present on an antigenpresenting cell. For example, a functional signaling domain derived froma stimulatory molecule is the zeta chain associated with the T cellreceptor complex.

The term “stimulatory ligand” refers to a ligand that when present on anantigen presenting cell (e.g., an APC, a dendritic cell, a B-cell, andthe like.) can specifically bind with a cognate binding partner(referred to herein as a “stimulatory molecule”) on a cell, for examplea T cell, thereby mediating a primary response by the T cell, includingactivation, initiation of an immune response, proliferation, and similarprocesses. Stimulatory ligands are well-known in the art and encompass,inter alia, an MHC Class I molecule loaded with a peptide, an anti-CD3antibody, a superagonist anti-CD28 antibody, and a superagonist anti-CD2antibody.

The term “therapeutic” refers to a treatment and/or prophylaxis. Atherapeutic effect is obtained by suppression, remission, or eradicationof a disease state or alleviating the symptoms of a disease state.

The term “therapeutically effective amount” refers to the amount of thesubject compound that will elicit the biological or medical response ofa tissue, system, or subject that is being sought by the researcher,veterinarian, medical doctor or another clinician. The term“therapeutically effective amount” includes that amount of a compoundthat, when administered, is sufficient to prevent the development of, oralleviate to some extent, one or more of the signs or symptoms of thedisorder or disease being treated. The therapeutically effective amountwill vary depending on the compound, the disease and its severity andthe age, weight, etc., of the subject to be treated.

The term “treat a disease” refers to the reduction of the frequency orseverity of at least one sign or symptom of a disease or disorderexperienced by a subject.

The term “transfected” or “transformed” or “transduced” refers to aprocess by which an exogenous nucleic acid is transferred or introducedinto the host cell. A “transfected” or “transformed” or “transduced”cell is one which has been transfected, transformed, or transduced withexogenous nucleic acid. The cell includes the primary subject cell andits progeny.

A “vector” is a polynucleotide that comprises an isolated nucleic acidand which can be used to deliver the isolated nucleic acid to theinterior of a cell. Numerous vectors are known in the art includinglinear polynucleotides, polynucleotides associated with ionic oramphiphilic compounds, plasmids, and viruses. Thus, the term “vector”includes an autonomously replicating plasmid or a virus. The term alsoincludes non-plasmid and non-viral compounds which facilitate transferof nucleic acid into cells, such as, for example, polylysine compounds,liposomes, and the like. Examples of viral vectors include, adenoviralvectors, adeno-associated virus vectors, retroviral vectors, and others.For example, lentiviruses are complex retroviruses, which, in additionto the common retroviral genes gag, pol, and env, contain other geneswith regulatory or structural function. Lentiviral vectors are wellknown in the art. Some examples of lentivirus include the HumanImmunodeficiency Viruses: HIV-1, HIV-2, and the Simian ImmunodeficiencyVirus: SIV. Lentiviral vectors have been generated by multiplyattenuating the HIV virulence genes, for example, the genes env, vif,vpr, vpu, and nef are deleted making the vector biologically safe.

Ranges: throughout this disclosure, various aspects of the disclosurecan be presented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of thedisclosure. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible subranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. Thisapplies regardless of the breadth of the range.

The present disclosure relates to isolated nucleic acid sequences,vectors including the isolated nucleic acid sequences, modified cells,and methods of treating cancer using these cells.

Some aspects of the present disclosure relate to a surprising discoverythat uses of an agent for culturing CAR cell in vitro may enhanceefficacy of CAR cells and/or efficiency of CAR cell preparation, achievelong-term in vitro maintenance of CAR cells, and/or induce CAR T cellsto produce phenotypes of memory T cells. In these instances, the CARexpressed by the CAR cell recognizes and/or binds the agent. In someembodiments, the agent is a regulatory compound that binds anextracellular component of the CAR and/or activates signaling pathwaysof the CAR to thereof stimulate T cells expressing the CAR. For example,the regulatory compound may bind the CAR of the T cells and mediates aresponse by the T cells, including activation, initiation of an immuneresponse, and/or proliferation.

Some aspects of the present disclosure relate to the modified Tcells/CAR T cells that can grow numerous times (i.e., proliferable cellsor longevity cells). Such proliferable cells remain functions of normalT cells/CAR T cells such as cell therapy functions. In some embodiments,a dual switch may be designed to regulate the growth of proliferable Tcells/CAR T cells. Embodiments herein design a mechanism that includesone or two control switches. The first switch includesrtTA-TRE-hTERT/SV40LT. rtTA-TRE is a eukaryotic cell-induced expressionof regulatory genes. By adding tetracycline to induce expression ofhTERT (human telomerase reverse transcriptase) or SV40LT (SV40 large Tantigen), phenotypes of immortalization may be produced. The secondregulatory switch is EF1a-TK. TK gene is a suicide gene. In the case ofadding ganciclovir, this agent will make the suicide gene exercisefunction to regulate the cell itself to die. In some embodiments, CAR Tcells with one or two control switches may make the CAR T cells survivelonger and retain relevant biological functions, while remainingeffective and safe. Further, T cells may be generated using, in additionto lentiviruses, various other methods, which are included in thepresent invention, such as a knock-in method to insert the genome intoanother and uses of other vectors (e.g., retroviral vectors).

Embodiments of the present disclosure relate to compositions and methodsfor treating conditions using Chimeric Antigen Receptor (CAR) cells. Theterm “Chimeric Antigen Receptor” or alternatively a “CAR” refers to arecombinant polypeptide construct comprising at least an extracellularantigen binding domain, a transmembrane domain and an intracellularsignaling domain (e.g., cytoplasmic domain). In some embodiments, thedomains in the CAR polypeptide construct are in the same polypeptidechain (e.g., comprising a chimeric fusion protein) or not contiguouswith each other (e.g., in different polypeptide chains).

In some embodiments, the intracellular signaling domain may include afunctional signaling domain derived from a stimulatory molecule and/or aco-stimulatory molecule as described above. In certain embodiments, theintracellular signaling domain includes a functional signaling domainderived from a primary signaling domain (e.g., a primary signalingdomain of CD3-zeta). In other embodiments, the intracellular signalingdomain further includes one or more functional signaling domains derivedfrom at least one co-stimulatory molecule. The co-stimulatory signalingregion refers to a portion of the CAR including the intracellular domainof a co-stimulatory molecule. Co-stimulatory molecules are cell surfacemolecules other than antigens receptors or their ligands that arerequired for an efficient response of lymphocytes to antigen.

Between the extracellular domain and the transmembrane domain of theCAR, there may be incorporated a spacer domain (i.e., a hinge domain).As used herein, the term “spacer domain” refers to any oligo- orpolypeptide that functions to link the transmembrane domain to, eitherthe extracellular domain or, the cytoplasmic domain in the polypeptidechain. A spacer domain may include up to 300 amino acids, preferably 10to 100 amino acids, and most preferably 25 to 50 amino acids.

The extracellular domain of a CAR may include an antigen binding domain(e.g., a scFv, a single domain antibody, or TCR (e.g., a TCR alphabinding domain or TCR beta binding domain)) that targets a specifictumor marker (e.g., a tumor antigen). Tumor antigens are proteins thatare produced by tumor cells that elicit an immune response, particularlyT cell mediated immune responses. Tumor antigens are well known in theart and include, for example, a glioma-associated antigen,carcinoembryonic antigen (CEA), β-human chorionic gonadotropin,alphafetoprotein (AFP), lectin-reactive AFP, thyroglobulin, RAGE-1,MN-CA IX, human telomerase reverse transcriptase, RU1, RU2 (AS),intestinal carboxyl esterase, mut hsp70-2, M-CSF, prostase,prostate-specific antigen (PSA), PAP, NY-ESO-1, LAGE-1a, p53, prostein,PSMA, Her2/neu, survivin telomerase, prostate-carcinoma tumor antigen-1(PCTA-1), MAGE, ELF2M, neutrophil elastase, ephrinB2, CD22, insulingrowth factor (IGF)-I, IGF-II, IGF-I receptor, and mesothelin. Forexample, if the tumor antigen is CD19, then the CAR thereof may bereferred as CD19 CAR, and the corresponding CAR cell may be referred asCD19 CAR cell (e.g., CD19 CAR T cell).

In some embodiments, the extracellular ligand-binding domain comprises ascFv comprising the light chain variable (VL) region and the heavy chainvariable (VH) region of a target antigen-specific monoclonal antibodyjoined by a flexible linker. Single chain variable region fragments aremade by linking light and/or heavy chain variable regions by using ashort linking peptide (Bird et al., Science 242:423-426, 1988). Anexample of a linking peptide is the GS linker having the amino acidsequence (GGGGS)3 (SEQ ID: 76), which bridges approximately 3.5 nmbetween the carboxy terminus of one variable region and the aminoterminus of the other variable region. Linkers of other sequences havebeen designed and used (Bird et al., 1988, supra). In general, linkerscan be short, flexible polypeptides and preferably comprised of about 20or fewer amino acid residues. Linkers can, in turn, be modified foradditional functions, such as attachment of drugs or attachment to solidsupports. The single chain variants can be produced either recombinantlyor synthetically. For synthetic production of scFv, an automatedsynthesizer can be used. For recombinant production of scFv, a suitableplasmid containing polynucleotide that encodes the scFv can beintroduced into a suitable host cell, either eukaryotic, such as yeast,plant, insect or mammalian cells, or prokaryotic, such as E. coli.Polynucleotides encoding the scFv of interest can be made by routinemanipulations such as ligation of polynucleotides. The resultant scFvcan be isolated using standard protein purification techniques known inthe art.

In some embodiments, the tumor antigen includes HER2, CD19, CD20, CD22,Kappa or light chain, CD30, CD33, CD123, CD38, ROR1, ErbB3/4, EGFR,EGFRvIII, EphA2, FAP, carcinoembryonic antigen, EGP2, EGP40, mesothelin,TAG72, PSMA, NKG2D ligands, B7-H6, IL-13 receptor α 2, IL-11 receptor α,MUC1, MUC16, CA9, GD2, GD3, HMW-MAA, CD171, Lewis Y, G250/CAIX, HLA-A1MAGE A1, HLA-A2 NY-ESO-1, PSC1, folate receptor-α, CD44v7/8, 8H9, NCAM,VEGF receptors, 5T4, Fetal AchR, NKG2D ligands, CD44v6, TEM1, TEM8, orviral-associated antigens expressed by the tumor. In some embodiments,the binding element of the CAR may include any antigen binding moietythat when bound to its cognate antigen, affects a tumor cell such thatthe tumor cell fails to grow, or is promoted to die or diminish.

In some embodiments relate to a genetically modified cell. In someembodiments, the modified cell may include a nucleic acid sequenceencoding hTERT, a nucleic acid encoding SV40LT, or a combinationthereof. In certain embodiments, the modified cell may include a firstnucleic acid sequence encoding hTERT and/or a second nucleic acidsequence encoding SV40LT. For example, the nucleic acid sequenceencoding hTERT has a sequence of SEQ ID NO: 6, and the nucleic acidsequence encoding SV40LT has a sequence of SEQ ID NO: 7.

In some embodiments, the modified cell is a T cell or an NK cell. Incertain embodiments, the modified cell is a proliferable T cell.Proliferable cells refer to genetically modified cells having higherproliferation capacity than that of wild type cells. Several techniquesmay be implemented to obtain the proliferable cells. For example, hTERT,SV40LT, and/or other genes may be transferred to a cell to obtain aproliferable cell. In some embodiments, mRNA encoding constructs (e.g.,hTERT and/or SV40LT) may be injected into cells to achieve transientgene expression in these cells. In other embodiments, vectors encodingconstructs (e.g., hTERT and/or SV40LT) may be introduced into cells toobtain proliferable cells. For example, at least a portion of a vectormay be integrated into the genome of the cells. In these instances, theintegration of the nucleic acid sequence encoding hTERT, a nucleic acidencoding SV40LT, or a combination thereof may include genomicintegration of the nucleic acid sequence encoding hTERT, a nucleic acidencoding SV40LT, or a combination thereof and constitutive expression ofhTERT, SV40LT, or a combination thereof.

Some embodiments relate to a multi-step control of ability ofproliferation, as described above. For example, a eukaryoticcell-induced expression system may be used to regulate the proliferationability of T cells. By continuing to add “tetracycline” to these cells,hTERT and/or SV40LT can be expressed; however, if provision oftetracycline is terminated, hTERT and/or SV40LT may not be expressed.Accordingly, this proliferation may be terminated. In some embodiments,Ef1α and TK suicide gene may be used to regulate the proliferationability. Since TK suicide gene function is an agent-sensitive gene,cells transferred with the system may die in the presence of the agent.Therefore, proliferation ability of T cells may be regulated in a safeand effective way.

In some embodiments, the expression of the nucleic acid sequenceencoding hTERT, a nucleic acid encoding SV40LT, or a combinationthereof, is regulated by an inducible expression system. For example,the inducible expression system is rTTA-TRE, which increases oractivates the expression of SV40LT gene, hTERT gene, or a combinationthereof. An inducible expression system allows for a temporal andspatial controlled activation and/or expression of genes. For example,Tetracycline-Controlled Transcriptional Activation is a method ofinducible gene expression where transcription is reversibly turned on oroff in the presence of the antibiotic tetracycline or one of itsderivatives (e.g., doxycycline). For example, an inducible suicide geneexpression system allows for a temporal and spatial controlledactivation and/or expression of a suicide gene, which causes a cell tokill itself through apoptosis.

In some embodiments, the modified cell may include a nucleic acidsequence encoding a suicide gene. For example, the suicide gene is anHSV-TK system.

In some embodiments, the modified cell may include a nucleic acidsequence encoding a CAR. For example, the CAR may include anextracellular domain, a transmembrane domain, and an intracellulardomain, and the extracellular domain binds a tumor antigen. In certainembodiments, the tumor antigen includes HER2, CD19, CD20, CD22, Kappa orlight chain, CD30, CD33, CD123, CD38, ROR1, ErbB3/4, EGFR, EGFRvIII,EphA2, FAP, carcinoembryonic antigen, EGP2, EGP40, mesothelin, TAG72,PSMA, NKG2D ligands, B7-H6, IL-13 receptor α 2, IL-11 receptor α, MUC1,MUC16, CA9, GD2, GD3, HMW-MAA, CD171, Lewis Y, G250/CAIX, HLA-A1 MAGEA1, HLA-A2 NY-ESO-1, PSC1, folate receptor-α, CD44v7/8, 8H9, NCAM, VEGFreceptors, 5T4, Fetal AchR, NKG2D ligands, CD44v6, TEM1, or TEM8. Incertain embodiments, the intracellular domain comprises a costimulatorysignaling domain that may include an intracellular domain of acostimulatory molecule selected from the group consisting of CD27, CD28,4-1BB, OX40, CD30, CD40, PD-1, ICOS, lymphocyte function-associatedantigen-1 (LFA-1), CD2, CD7, LIGHT, NKG2C, B7-H3, and any combinationthereof. For example, the intracellular domain may include a CD3 zetasignaling domain. In certain embodiments, the nucleic acid encoding CAR,the nucleic acid encoding nhTERT, the nucleic acid encoding SV40LT, or acombination thereof is expressed as gene products that are separatepolypeptides.

In some embodiments, the TCR gene of the T cell is disrupted such thatexpression of the endogenous TCR is reduced. In certain embodiments, atargeting vector associated with the TCR gene is integrated into thegenome of the T cell such that the expression of the endogenous TCR iseliminated.

In some embodiments, the CD4 gene of the T cell is disrupted such thatexpression of the endogenous CD4 is reduced. In certain embodiments, anantigen binding domain of the CAR binds a molecule on the surface ofHIV.

Some embodiments relate to a method for preparing the modified cellhaving a CAR (CAR cell). In some embodiments, the method may includeproviding a cell; and introducing a nucleic acid sequence encoding a CARand a nucleic acid sequence encoding hTERT, SV40LT, or a combinationthereof, into the cell. In some embodiments, the integration of thenucleic acid sequence encoding hTERT, a nucleic acid encoding SV40LT, ora combination thereof includes genomic integration of the nucleic acidsequence encoding hTERT, a nucleic acid encoding SV40LT, or acombination thereof and constitutive expression of hTERT, SV40LT, or acombination thereof. In some embodiments, the expression of the nucleicacid sequence encoding hTERT, SV40LT, or a combination thereof, isregulated by an inducible expression system. In some embodiments, themethod may further include culturing the CAR cell in the presence of anagent that the extracellular domain of the CAR recognizes.

In some embodiments, the method may further include introducing anucleic acid sequence encoding a suicide gene into the cell. In certainembodiments, the agent is a regulatory compound that binds anextracellular component of the CAR and mediates a response by the cells.

For example, the regulatory compound is a ligand for the extracellulardomain of the CAR or an antigen that extracellular domain of the CARbinds. In certain embodiments, the agent is the extracellular domain ofan antigen that the extracellular domain of the CAR binds. For example,antigen is Epidermal growth factor receptor (EGFR), Variant III of theepidermal growth factor receptor (EGFRvIII), Human epidermal growthfactor receptor 2 (HER2), Mesothelin (MSLN), Prostate-specific membraneantigen (PSMA), Carcinoembryonic antigen (CEA), Disialoganglioside 2(GD2), Interleukin-13Ra2 (IL13Rα2), Glypican-3 (GPC3), Carbonicanhydrase IX (CAIX), L1 cell adhesion molecule (L1-CAM), Cancer antigen125 (CA125), Cluster of differentiation 133 (CD133), Fibroblastactivation protein (FAP), Cancer/testis antigen 1B (CTAG1B), Mucin 1(MUC1), Folate receptor-α (FR-α), CD19, FZD10, TSHR, PRLR, Muc 17,GUCY2C, CD207, CD3, CD5, B-Cell Maturation Antigen (BCMA), or CD4. Incertain embodiments, the agent is an antibody that binds theextracellular domain of the CAR. For example, the antibody is a humanIgG antibody and/or binds a Fab fragment of a human IgG. In certainembodiments, the regulatory compound comprises an extracellular domainof at least one of CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3,CD5, or CD4. In some instances, the regulatory compound comprises atleast one of amino acid SEQ IDs: 41-47. In some instances, theregulatory compound binds at least one of amino acid sequences: SEQ IDs:21 and 48-B3. In some instances, the CAR cell may include at least onesequence of SEQ ID Nos: 38, 35, 39, and 40.

In some embodiments, the CAR cell exhibits about a 1.5 to 2 foldincrease in cell growth as compared to the CAR cells cultured withoutthe agent. In certain embodiments, the CAR cells exhibit about a 1.5 to3 fold increase in cell growth as compared to the CAR cells culturedwithout the agent. In certain embodiments, the CAR cells exhibit about a2 fold increase in cell growth as compared to the CAR cells culturedwithout the agent.

In some embodiments, the cell density of the CAR cells in the culturemedium is at least 25 cells/ml of cell culture medium. In certainembodiments, the cell density of the CAR cells is less than 200×104cells/ml of cell culture medium. In certain embodiments, the celldensity of the CAR cells is between 50×104 to 200 cells/ml of cellculture medium. In certain embodiments, the cell density of the CARcells between 50×104 to 100×104 cells/ml of cell culture medium.

In some embodiments, the CAR cells are sensitive to tetracycline in thecell culture medium. For example, the CAR cells comprise a third nucleicacid sequence encoding a reverse tetracycline transactivator (rtTA). Incertain embodiments, the expression of hTERT, SV40LT is regulated by thertTA such that hTERT, SV40LT is expressed in the presence oftetracycline. For example, the tetracycline is selected from the groupof tetracycline, demeclocycline, meclocycline, doxycycline, lymecycline,methacycline, minocycline, oxytetracycline, rolitetracycline, andchlortetracycline. In specific embodiments, the tetracycline isdoxycycline. In certain embodiments, a concentration of tetracycline inthe cell culture medium is not less than 2 μg/ml.

In some embodiments, the CAR cell may include a fourth nucleic acidsequence encoding a suicide gene such that the CAR cells are culturedwith a nucleoside analogue in a manner permitting expression of thesuicide gene to render nucleoside analogue cytotoxic. For example, thesuicide gene is selected from the group consisting of thymidine kinaseof herpes simplex virus, thymidine kinase of varicella zoster virus, andbacterial cytosine deaminase. In specific embodiments, the suicide geneis thymidine kinase of herpes simplex virus. In certain embodiments, thenucleoside analogue is selected from the group consisting ofganciclovir, acyclovir, buciclovir, famciclovir, penciclovir,valciclovir, trifluorothymidine, 1-[2-deoxy, 2-fluoro, beta-D-arabinofuranosyl]-5-iodouracil, ara-A, araT 1-beta-D-arabinofuranoxyl thymine,5-ethyl-2′-deoxyuridine, 5-iodo-5′-amino-2,5′-dideoxyuridine,idoxuridine, AZT, AIU, dideoxycytidine, and AraC. In specificembodiments, the nucleoside analogue is ganciclovir.

Some embodiments relate to an isolated cell obtained using the methoddescribed above. In some embodiments, a composition comprising apopulation of the isolated cell. In some embodiments, a method ofenhancing T-cell response in a subject and/or treating a tumor of thesubject may include administering an effective amount of thecomposition.

In some embodiments relate to a method of generating a CAR T cell. Themethod may include proliferating a T cell by transferring one or morenucleic acid sequences to the T cell to obtain proliferable T cells; andintroducing a nucleic acid sequence encoding a CAR into the proliferatedT cells to obtain CAR T cells, wherein the CAR comprising anextracellular domain, a transmembrane domain, and an intracellulardomain. For example, the one or more nucleic acid sequences compriseTet-inducible HPV16-E6/E7 expression system.

In some embodiments, the T cell is a primary T cell extracted from asubject. In some embodiments, the T cell is a T cell having decreasedimmunogenicity as compared to a corresponding wild-type T cell inresponse to a T cell transfusion.

Some embodiments relate to a method of treating a disease or condition.The method may include administering to the human patient thepharmaceutical composition (e.g., a population of modified T cells)described herein. In certain embodiments, the disease or condition isAIDS, and an antigen binding domain of the CAR binds a molecule on thesurface of HIV. In certain embodiments, the disease or condition iscancer, and an antigen binding domain of the CAR binds a molecule on acancer cell, and the number of endogenous TCRs is reduced.

Some embodiments relate to a CAR T cell that includes a nucleic acidsequence encoding a CAR that comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule,wherein the TCR gene of the T cell is disrupted such that expression ofthe TCR is eliminated.

Some embodiments relate to a CAR T cell that includes a nucleic acidsequence encoding a CAR that comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule,wherein CD4 gene of the T cell is disrupted such that expression of theendogenous CD4 is reduced. For example, an antigen binding domain of theCAR binds a molecule on the surface of HIV and/or tumor cells.

Some embodiments relate to a method of producing conditionallyproliferable T cells.

The method may include transferring one or more nucleic acid sequencesto the T cells to obtain proliferable T cells, wherein the one or morenucleic acid sequences encode a peptide such that expression of thepeptide causes the T cells to become proliferable T cells, and thepeptide is regulated by an inducible expression system, an induciblesuicide system, or a combination thereof. In some embodiments, thepeptide is hTERT, SV40LT, or a combination thereof. In certainembodiments, the inducible expression system is rtTA-TRE. In certainembodiments, the inducible suicide system is an HSV-TK system or aninducible caspase-9 system.

Some embodiments relate to a method of treating a disease or condition.The method may include preparing conditionally proliferable T cellsusing the method described herein; culturing the conditionallyproliferable T cells in a medium containing tetracycline or doxycycline;culturing the conditionally proliferable T cell in a medium without anytetracycline or doxycycline to obtain T cells of which the expression ofSV40LT gene or hTERT gene is reduced; and administering to a subject apharmaceutical composition comprising the obtained T cells.

Some embodiments relate to a pharmaceutical composition obtained using amethod described herein for use in the treatment of a disease orcondition including preparing conditionally proliferable T cells usingthe method; culturing the conditionally proliferable T cells in a mediumcontaining tetracycline or doxycycline; culturing the conditionallyproliferable T cell in a medium without any tetracycline or doxycyclineto obtain T cells of which the expression of SV40LT gene or hTERT geneis reduced; and administering to a subject a pharmaceutical compositioncomprising the obtained T cells. In certain embodiments, the method mayfurther include administrating ganciclovir to the subject in response toa certain predetermined condition.

In some embodiments, an endogenous gene associated with a biosynthesisor transportation pathway of the TCR gene of the modified cell isdisrupted such that expression of the endogenous TCR is reduced.

Some embodiments relate to a population of T cells comprising themodified cell described herein. In some embodiments, an endogenous geneassociated with a biosynthesis or transportation pathway of PD-1 gene ofthe modified cell is disrupted such that expression of the endogenousTCR is reduced. In certain embodiments, the modified cell comprises anucleic acid sequence that encodes truncated PD-1 that reduces aninhibitory effect of programmed death ligand 1 (PD-L1) on a human Tcell.

In some embodiments relate to a method for preparation of modifiedcells. In some embodiments, the method may include obtaining cellscomprising a chimeric antigen receptor (CAR); and culturing the cells inthe presence of an agent that an extracellular domain of the CARrecognizes. In some embodiments, the method may be implemented for invitro CAR cell preparation. The method may include providing cells;introducing a nucleic acid sequence encoding a CAR into the cells toobtain the CAR cells; and culturing the CAR cells in the presence of anagent that an extracellular domain of the CAR recognizes. In someembodiments, the method may be implemented to enrich cells expressing aCAR. The method may include providing cells; introducing a nucleic acidsequence encoding the CAR into the cells to obtain cells expressing theCAR (CAR cells) and cells not expressing the CAR; and culturing the CARcells in the presence of an agent that binds an extracellular domain ofthe CAR to enrich the cells expressing the CAR. In some embodiments, themethod may be implemented for in vitro CAR cell preparation. The methodmay include the following steps in the order named: (a) introducing anucleic acid sequence encoding a CAR to the cells to obtain the CARcells; (b) culturing the CAR cells using a first medium for apredetermined time; and (c) culturing the CAR cells using a secondmedium, wherein the first medium does not contain an agent; the secondmedium contains the agent, and the agent binds an extracellular domainof the CAR.

Some embodiments relate to isolated cells obtained by the methods aboveand a pharmaceutical composition containing the isolated cells. Someembodiments relate to a method for stimulating an anti-tumor immuneresponse in a subject. The method comprising administering to thesubject an effective amount of the pharmaceutical composition. Someembodiments relate to the pharmaceutical composition for use in thetreatment of cancer comprising administering to the subject an effectiveamount of the pharmaceutical composition.

In some embodiments, the agent is a regulatory compound that binds anextracellular component of the CAR and mediates a response by the cells.In certain embodiments, the regulatory compound is a ligand for theextracellular domain of the CAR or an antigen that the extracellulardomain of the CAR binds. In certain embodiments, the regulatory compoundis an antibody that binds the extracellular domain of the CAR. In someinstances, the antibody is a human IgG antibody and/or binds a Fabfragment of a human IgG. In certain embodiments, the regulatory compoundmay include an extracellular domain of at least one of CD19, FZD10,TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, or CD4. In certainembodiments, the regulatory compound comprises at least one of aminoacid sequences: SEQ IDs: 41-47 and 61-63. In certain embodiments, theregulatory compound binds at least one of amino acid sequences: SEQ IDs:55, 21, 48, 49, 40, 51-53, and 56-60. In certain embodiments, theregulatory compound comprises at least one of GCC, B7-H4, Prostatespecific membrane antigen (PSMA), Carcinoembryonic Antigen (CEA),IL13Ralpha, her-2, CD19, CD20, CD22, CD123, NY-ES0-1, HIV-I Gag, LewisY, Mart-I, gplOO, tyrosinase, WT-I, h TERI, MUC16, mesothelin, MIC-A,MIC-B, estrogen, progesterone, RON, or one or more members of theULBP/RAETI family. In certain embodiments, the regulatory compound is asoluble antigen generated by a eukaryotic system or a bacterialexpression system.

In some embodiments, a “soluble antigen” is a polypeptide that is notbound to a cell membrane. Soluble antigens are most commonlyligand-binding polypeptides (e.g., receptors) that lack transmembraneand cytoplasmic domains. Soluble antigens may include additional aminoacid residues, such as affinity tags that provide for purification ofthe polypeptide or provide sites for attachment of the polypeptide to asubstrate, or immunoglobulin constant region sequences. Soluble antigenpolypeptides are said to be substantially free of transmembrane andintracellular polypeptide segments when they lack sufficient portions ofthese segments to provide membrane anchoring or signal transduction,respectively. For example, many cell-surface receptors have naturallyoccurring, while soluble counterparts that are produced by proteolysis.

In some embodiments, the agent is the extracellular domain of an antigenthat the extracellular domain of the CAR binds. In certain embodiments,the antigen is Epidermal growth factor receptor (EGFR), Variant III ofthe epidermal growth factor receptor (EGFRvIII), Human epidermal growthfactor receptor 2 (HER2), Mesothelin (MSLN), Prostate-specific membraneantigen (PSMA), Carcinoembryonic antigen (CEA), Disialoganglioside 2(GD2), Interleukin-13Ra2 (IL13Rα2), Glypican-3 (GPC3), Carbonicanhydrase IX (CAIX), L1 cell adhesion molecule (L1-CAM), Cancer antigen125 (CA125), Cluster of differentiation 133 (CD133), Fibroblastactivation protein (FAP), Cancer/testis antigen 1B (CTAG1B), Mucin 1(MUC1), Folate receptor-α (FR-α), CD19, FZD10, TSHR, PRLR, Muc 17,GUCY2C, CD207, CD3, CD5, B-Cell Maturation Antigen (BCMA), or CD4.

In some embodiments, the CAR comprises an extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule. Incertain embodiments, the costimulatory molecule of CAR comprises atleast one of CD27, CD28, 4-IBB, OX40, CD30, CD40, PD-L ICOS, lymphocytefunction-associated antigen-I (LFA-1), CD2, CD7, LIGHT, NKG2C, or B7-H3.

In some embodiments, the cells are an NK cell, a T cell, or acombination thereof. For example, the cells are T cells derived fromprimary T cells obtained from a healthy donor or a subject.

In some embodiments, after culturing the CAR cells with an agent, aratio of an amount of the agent and the number of CAR cells is 1:50 to1:5 (μg/104 cell), 1:500 to 1:5 (μg/104 cell), or 1:5000 to 10:5 (μg/104cell). In certain embodiments, a ratio of an amount of the agent and thenumber of CAR cells is 1:50 to 1:5 (μg/104 cell).

In some embodiments, the culture medium includes at least one ofanti-CD3 beads, anti-CD28 beads, and IL2.

In some embodiments, the number of copies of CAR on the CAR cells isgreater than the number when the CAR cells are cultured without theagent. In certain embodiments, a ratio of a number of the cellsexpressing the CAR and the cells not expressing the CAR is greater thanthe ratio when the cells are cultured without the agent.

In some embodiments, the CAR cells may be cultured in the presence ofthe agent for a predetermined period of time, or in the presence of theagent for at least 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20,21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 days. For example, thepredetermined period of time is from 7-100 days. In other embodiments,the CAR cells may be cultured without the agent for at least 8, 9, 10,11, 12, or 13 days after the introduction of a vector comprising anucleic acid sequence encoding the CAR into the cells, and then culturedwith the agent. In specific embodiments, the CAR cells may be culturedwithout the agent for about 10 days after the introduction of a vectorcomprising a nucleic acid sequence encoding the CAR into the cells, andthen cultured with the agent. In certain embodiments, culturing the Tcells in the presence of the agent comprises culturing the T cells withor without the agent for at least 8 days after introduction of a vectorcomprising a nucleic acid sequence encoding the CAR into the T cells,and then culturing the T cells with the agent after the at least 8 days.In certain embodiments, the culturing the T cells in the presence of theagent comprises culturing the T cells with or without the agent at least10 days after introduction of a vector comprising a nucleic acidsequence encoding the CAR into the T cells, and then culturing the Tcells with the agent after the at least 10 days.

In some embodiments, the number of the CAR cells producing a phenotypeof memory T cells when cultured in the presence of an agent is greaterthan the number when the CAR cells are cultured without the agent.

In some embodiments, an amount of a cytokine produced by the CAR cellsis greater than the amount of a cytokine produced by CAR cells when theCAR cells are cultured without the agent.

In some embodiments, the CAR cells are derived from a healthy donor andhave a reduced expression of the endogenous TCR gene and/or HLA I. Incertain embodiments, the CAR cells are derived from a healthy donor andelicit no graft-versus-host disease (GVHD) response or a reduced GVDHresponse in a human recipient as compared to the GVHD response elicitedby a primary human T cell isolated from the same human donor and havingno reduced expression of the endogenous TCR gene and/or HLA I, or thatthe expression of the endogenous TCR gene and/or HLA I is not disruptedand the endogenous TCR gene and/or HLA I are expressed as normal.

In some embodiments, the CAR T cells are T cells comprising a nucleicacid sequence encoding hTERT, a nucleic acid encoding SV40LT, or acombination thereof. In certain embodiments, the CAR T cells may includea nucleic acid sequence encoding hTERT and a nucleic acid encodingSV40LT. In certain embodiments, the expression of hTERT is regulated byan inducible expression system. In certain embodiments, the expressionof SV40LT gene is regulated by an inducible expression system. Incertain embodiments, the inducible expression system is rtTA-TRE, whichincreases or activates the expression of SV40LT gene, the hTERT gene, ora combination thereof.

In some embodiments, the CAR cell may include a nucleic acid sequenceencoding a suicide gene. In certain embodiments, the suicide gene is anHSV-TK system.

Some embodiments relate to a method of in vivo cell expansion. In someembodiments, the method may include administering an effective amount ofT cell comprising a CAR to the subject to provide a T cell response; andadministering an effective amount of presenting cells expressing asoluble agent that an extracellular domain of the CAR recognizes. Insome embodiments, the method may be implemented to enhance T cellresponse in a subject. The method may include administering an effectiveamount of T cell comprising a CAR to the subject to provide a T cellresponse, and administering an effective amount of presenting cellsexpressing a soluble agent that an extracellular domain of the CARrecognizes to enhance the T-cell response in the subject. In certainembodiments, the presenting cells are T cells, dendritic cells, and/orantigen presenting cells. In certain embodiments, the enhancing T cellresponse in the subject may include selectively enhancing proliferationof T cell comprising the CAR. In some embodiments, the method may beused to enhance treatment of a condition on a subject using CAR cells.The method may include administering a population of cells that expressan agent or the agent that is formulated as a vaccine. In theseinstances, the CAR cells may include a nucleic acid sequence thatencodes a CAR, and an extracellular domain of the CAR may recognize theagent. In some embodiments, the method may be implemented to enhanceproliferation of CAR cells in a subject having a disease. The method mayinclude preparing CAR cells comprising a CAR; administering an effectiveamount of the CAR cells to the subject; introducing, into cells, anucleic acid sequence encoding an agent that an extracellular domain ofthe CAR recognizes, and administering an effective amount of the cellsto the subject.

The T cell response in a subject refers to cell-mediated immunityassociated with a helper, killer, regulatory, and other types of Tcells. For example, T cell response may include activities such asassistance to other white blood cells in immunologic processes andidentifying and destroying virus-infected cells and tumor cells. T cellresponse in the subject may be measured via various indicators such as anumber of virus-infected cells and/or tumor cells that T cells kill, anamount of cytokines that T cells release in co-culturing withvirus-infected cells and/or tumor cells, a level of proliferation of Tcells in the subject, a phenotype change of T cells (e.g., changes tomemory T cells), and a level longevity or lifetime of T cells in thesubject.

In some embodiments, the in vitro killing assay may be performed bymeasuring the killing efficacy of CAR T cells by co-culturing CAR Tcells with antigen-positive cells. CAR T cells may be considered to havea killing effect on the corresponding antigen-positive cells by showinga decrease in the number of corresponding antigen-positive cellsco-cultured with CAR T cells and an increase in the release of IFNγ,TNFα, etc. as compared to control cells that do not express thecorresponding antigen. Further, in vivo antitumor activity of the CAR tcells may be tested. For example, xenograft models may be establishedusing the antigens described herein in immunodeficient mice.Heterotransplantation of human cancer cells or tumor biopsies intoimmunodeficient rodents (xenograft models) has, for the past twodecades, constituted the major preclinical screen for the development ofnovel cancer therapeutics (Song et al., Cancer Res. PMC 2014 Aug. 21,and Morton et al., Nature Protocols, 2, -247-250 (2007)). To evaluatethe anti-tumor activity of CAR T cells in vivo, immunodeficient micebearing tumor xenografts can be used to evaluate CAR T's anti-tumoractivity (e.g., a decrease in mouse tumors and mouse blood IFNγ, TNFα,and others. and/or retention time of CAR T in bone marrow/peripheralblood/spleen of the mice).

In some embodiments, the agent is a ligand for the extracellular domainof the CAR. In certain embodiments, the agent is an antigen that theextracellular domain of the CAR binds. In certain embodiments, the agentcomprises an extracellular domain of at least one of Epidermal growthfactor receptor (EGFR), Variant III of the epidermal growth factorreceptor (EGFRvIII), Human epidermal growth factor receptor 2 (HER2),Mesothelin (MSLN), Prostate-specific membrane antigen (PSMA),Carcinoembryonic antigen (CEA), Disialoganglioside 2 (GD2),Interleukin-13Ra2 (IL13Rα2), Glypican-3 (GPC3), Carbonic anhydrase IX(CAIX), L1 cell adhesion molecule (L1-CAM), Cancer antigen 125 (CA125),Cluster of differentiation 133 (CD133), Fibroblast activation protein(FAP), Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folatereceptor-α (FR-α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3,CD5, or CD4. In certain embodiments, the agent comprises at least one ofamino acid sequences: SEQ IDs: 41-47 and 61-63. In certain embodiments,the agent binds at least one of amino acid sequences: SEQ IDs: 55, 21,48, 49, 40, 51-53, and 56-60. In certain embodiments, the agentcomprises at least one of GCC, B7-H4, Prostate specific membrane antigen(PSMA), Carcinoembryonic Antigen (CEA), IL13Ralpha, her-2, CD19, CD20,CD22, CD123, NY-ESO-1, HIV-1 Gag, Lewis Y, Mart-I, gplOO, tyrosinase,WT-I, h TERI, MUC16, mesothelin, MIC-A, MIC-B, estrogen, progesterone,RON, or one or more members of the ULBP/RAETI family.

In some embodiments, the CAR comprises the extracellular domain, atransmembrane domain, and an intracellular domain comprising a CD3-zetasignaling domain and a signaling domain of a costimulatory molecule. Incertain embodiments, the costimulatory molecule of CAR comprises atleast one of CD27, CD28, 4-IBB, OX40, CD30, CD40, PD-L ICOS, lymphocytefunction-associated antigen-I (LFA-1), CD2, CD7, LIGHT, NKG2C, or B7-H3.

In some embodiments, the cells or the isolated cells are NK cells, Tcells, or a combination thereof. In certain embodiments, the cells areattenuated to be viable and replication incompetent. In certainembodiments, the cells are attenuated to be viable and replicationincompetent by gamma irradiation or chemical inactivation. In certainembodiments, the cells or the isolated modified cell is obtained fromthe peripheral blood mononuclear cells (PBMC) of the subject. In certainembodiments, the cells are the T cells of the subject or a healthydonor. In certain embodiments, the cells are the T cells formulated as avaccine. In certain embodiments, the cells are an attenuated tumor cell.In certain embodiments, the cells are modified cells that have reducedimmunogenicity for an allogeneic CAR therapy, as compared to a wild-typecell.

In some embodiments, the agent is expressed by the cells, and theexpression of the agent is regulated by an inducible expression system.In certain embodiments, the agent is expressed by the cells, and theexpression of the agent is regulated by an inducible suicide geneexpression system. In certain embodiments, the agent is a solubleantigen such that the antigen is released by the cells.

Some embodiments relate to an isolated nucleic acid sequence encoding aCAR having a spacer domain. In some embodiments, the isolated nucleicacid sequence may encode a CAR having an extracellular domain, a spacerdomain, a transmembrane domain, and an intracellular domain, wherein theextracellular domain binds a tumor antigen, and the spacer domaincomprises an amino acid sequence of SEQ ID NO.: 68 or 69. In someembodiments, the isolated nucleic acid sequence may encode a CAR havingan extracellular domain, a spacer domain, a transmembrane domain, and anintracellular domain, wherein the extracellular domain binds a tumorantigen, the spacer domain comprises an amino acid sequence of SEQ IDNO.: 68, and the transmembrane domain comprises an amino acid sequenceof SEQ ID NO.: 72 or 75.

Some embodiments relate to a vector comprising an isolated nucleic acidsequence and to a cell comprising the isolated nucleic acid sequence.For example, the cell may be an NK cell, a T cell, or a combinationthereof. Some embodiments relate to a composition comprising apopulation of T cells having the isolated nucleic acid sequence.

Some embodiments relate to a method for preparing cells having the CARand uses thereof. In some embodiments, the method may be implemented forstimulating an anti-tumor immune response or treating a condition in asubject. The method may include administering to the subject aneffective amount of a pharmaceutical composition comprising a populationof human T cell comprising the isolated nucleic acid sequence. In someembodiments, the method may include obtaining cells comprising theisolated nucleic acid sequence; and culturing the cells in the presenceof an agent that an extracellular domain of the CAR recognizes. In someembodiments, the method may be implemented for in vitro CAR cellpreparation. The method may include providing cells; introducing theisolated nucleic acid sequence into the cells to obtain the CAR cells;and culturing the CAR cells in the presence of an agent that anextracellular domain of the CAR recognizes. In some embodiments, themethod may be implemented for enriching cells expressing a CAR. Themethod may include providing cells; introducing the isolated nucleicacid sequence of into the cells to obtain cells expressing the CAR (CARcells) and cells not expressing the CAR; and culturing the CAR cells inthe presence of an agent that binds an extracellular domain of the CARto enrich the cells expressing the CAR.

In some embodiments, the antigen binding domain includes an antibody, aligand, or an antigen-binding fragment thereof. In certain embodiments,the antigen-binding fragment includes a Fab or a scFv. In certainembodiments, the tumor antigen includes HER2, CD19, CD20, CD22, Kappa orlight chain, CD30, CD33, CD123, CD38, ROR1, ErbB3/4, EGFR, EGFRvIII,EphA2, FAP, carcinoembryonic antigen, EGP2, EGP40, mesothelin, TAG72,PSMA, NKG2D ligands, B7-H6, IL-13 receptor α 2, IL-11 receptor α, MUC1,MUC16, CA9, GD2, GD3, HMW-MAA, CD171, Lewis Y, G250/CAIX, HLA-A1 MAGEA1, HLA-A2 NY-ESO-1, PSC1, folate receptor-α, CD44v7/8, 8H9, NCAM, VEGFreceptors, 5T4, Fetal AchR, NKG2D ligands, CD44v6, TEM1, or TEM8. Incertain embodiments, the intracellular domain comprises a costimulatorysignaling region that includes an intracellular domain of acostimulatory molecule selected from the group consisting of CD27, CD28,4-1BB, OX40, CD30, CD40, PD-1, ICOS, lymphocyte function-associatedantigen-1 (LFA-1), CD2, CD7, LIGHT, NKG2C, B7-H3, and any combinationthereof. In certain embodiments, the intracellular domain comprises aCD3 zeta signaling domain.

In some embodiments, the agent is a ligand for the extracellular domainof the CAR. In certain, the agent is an antigen that extracellulardomain of the CAR binds. In certain embodiments, the agent is theextracellular domain of the antigen. In certain embodiments, the antigenis Epidermal growth factor receptor (EGFR), Variant III of the epidermalgrowth factor receptor (EGFRvIII), Human epidermal growth factorreceptor 2 (HER2), Mesothelin (MSLN), Prostate-specific membrane antigen(PSMA), Carcinoembryonic antigen (CEA), Disialoganglioside 2 (GD2),Interleukin-13Ra2 (IL13Rα2), Glypican-3 (GPC3), Carbonic anhydrase IX(CAIX), L1 cell adhesion molecule (L1-CAM), Cancer antigen 125 (CA125),Cluster of differentiation 133 (CD133), Fibroblast activation protein(FAP), Cancer/testis antigen 1B (CTAG1B), Mucin 1 (MUC1), Folatereceptor-α (FR-α), CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3,CD5, or CD4. In certain embodiments, the agent is an antibody that bindsthe extracellular domain of the CAR. In certain embodiments, theantibody is a human IgG antibody. For example, the antibody binds a Fabfragment of a human IgG. In certain embodiments, the agent comprises anextracellular domain of at least one of CD19, FZD10, TSHR, PRLR, Muc 17,GUCY2C, CD207, CD3, CD5, or CD4.

In certain embodiments, the agent comprises at least one of amino acidSEQ IDs: 22 and 34. In certain embodiments, the agent binds at least oneof amino acid SEQ IDs: 55, 21, 48, 49, 40, and 50-60. In certainembodiments, the agent activates the CAR and/or causes a co-stimulatoryresponse of the cells.

The nucleic acid sequences coding for the desired molecules can beobtained using recombinant methods known in the art, such as, forexample by screening libraries from cells expressing the gene, byderiving the gene from a vector known to include the same, or byisolating directly from cells and tissues containing the same, usingstandard techniques. Alternatively, the gene of interest can be producedsynthetically, rather than cloned.

The embodiments of the present disclosure further relate to vectors inwhich a DNA of the present disclosure is inserted. Vectors derived fromretroviruses such as the lentivirus are suitable tools to achievelong-term gene transfer since they allow long-term, stable integrationof a transgene and its propagation in daughter cells. Lentiviral vectorshave the added advantage over vectors derived from oncoretroviruses suchas murine leukemia viruses in that they can transduce non-proliferatingcells, such as hepatocytes. They also have the added advantage of lowimmunogenicity.

The expression of natural or synthetic nucleic acids encoding CARs istypically achieved by operably linking a nucleic acid encoding the CARpolypeptide or portions thereof to one or more promoters andincorporating the construct into an expression vector. The vectors canbe suitable for replication and integration eukaryotes. Typical cloningvectors contain transcription and translation terminators, initiationsequences, and promoters useful for regulation of the expression of thedesired nucleic acid sequence.

Additional information related to expression synthetic nucleic acidsencoding CARs and gene transfer into mammalian cells is provided in U.S.Pat. No. 8,906,682, incorporated by reference in its entirety.

The embodiments further relate to methods for treating a patient forillness including administering to the patient an effective amount ofthe engineered cells of the present disclosure. Various illnesses can betreated according to the present methods including cancer, such asovarian carcinoma, breast carcinoma, colon carcinoma, glioblastomamultiforme, prostate carcinoma and leukemia. In some embodiments, themethod includes administering to a human patient a pharmaceuticalcomposition including an antitumor effective amount of a population ofhuman T cells, wherein the human T cells of the population include humanT cells that comprises the nucleic acid sequence as described in thepresent disclosure.

Some embodiments relate to compositions and methods for treating T cellleukemia. A modified cell may include a nucleic acid sequence encoding achimeric antigen receptor (CAR) and a disruption of one or more exons ofa gene associated with a cluster of differentiation molecule (CD). Inthese instances, an extracellular domain of the CAR recognizes the CDmolecule. In certain embodiments, the CD molecule comprises CD2, CD3,CD4, CD5, CD7, CD8, or CD52. In other embodiments, the modified cell isa CAR NK cell or a CAR T cell.

T cell leukemia includes several different types of lymphoid leukemiawhich affect T cells: large granular lymphocytic leukemia, adult T cellleukemia/lymphoma, T cell prolymphocytic leukemia. For example, adultT-cell leukemia/lymphoma is often aggressive (fast-growing) T-celllymphoma that can be found in the blood (leukemia), lymph nodes(lymphoma), skin, or multiple areas of the body. The chimeric antigenreceptor T (CAR T) cell therapy is a newly developed adoptive antitumortreatment and has been proven to be effective for treating certainleukemia (e.g., B-cell lymphomas and B-cell chronic lymphocyticleukemia). However, conventional techniques of CAR T targeting wouldharm T cells including CAR T cells due to the issue of fratricide. Someembodiments use gene editing technology to modify certain genes of T/NKcells. For example, certain cluster of differentiation (CD) gene orrelated genes may be modified such that the modified cells may kill Tcell tumor and avoid CAR T/NK cells from attacking each other.

In some embodiments, the CAR comprises the extracellular domain, atransmembrane domain, and an intracellular domain; the extracellulardomain binds an antigen. In certain embodiments, the intracellulardomain comprises a costimulatory signaling region that comprises anintracellular domain of a costimulatory molecule selected from the groupconsisting of CD27, CD28, 4-1BB, OX40, CD30, CD40, PD-1, ICOS,lymphocyte function-associated antigen-1 (LFA-1), CD2, CD7, LIGHT,NKG2C, B7-H3, and any combination thereof.

In some embodiments, the modified cell comprises a disruption of anendogenous gene associated with a biosynthesis or transportation pathwayof CD2, CD3/TCR, CD4, CD5, CD7, CD8, or CD52 genes. In certainembodiments, the gene associated with the CD molecule is CD3/TCR gene,and the modified cell has a reduced amount of at least one of TCRsubunits, or CD3 subunits, such as CD3γ, CD3δ, CD3ε, or CD3ζ subunit.Additional information of CD3 and disruption of CD3 subunit expressioncan be found in “A PCR-Based Method to Genotype Mice Knocked Out for AllFour CD3 Subunits, the Standard Recipient Strain for Retrogenic TCR/CD3Bone Marrow Reconstitution Technology,” Alejandro Ferrer, Adam G.Schrum, and Diana Gil, BioResearch Open Access 2013 2:3, 222-226, whichis incorporated by reference in its entirety. In certain embodiments,the gene associated with the CD molecule is CD3/TCR gene, the modifiedcell has a reduced amount of at least one of TRAC, CD3γ, CD3δ, or CD3εsubunits. In certain embodiments, the gene associated with the CDmolecule is CD3/TCR gene, and the modified cell has a reduced expressionof TRAC, CD3γ, CD3δ, and CD3ε subunits. In certain embodiments, theextracellular domain of the CAR binds CD3 or TCR, and the modified cellelicits a reduced amount or no T cell response caused by anothermodified cell in a subject as compared to the T cell response elicitedby a cell that comprises the CAR of which the extracellular domain bindsCD3 or TCR and does not have the disruption of endogenous CD3/TCR. Incertain embodiments, the extracellular domain of the CAR comprises theamino acid sequence ID: 57. In certain embodiments, the extracellulardomain of the CAR comprises the amino acid sequence ID: 88 and/or 89. Incertain embodiments, the CD molecule is CD3, and the extracellulardomain of the CAR comprises the amino acid sequence ID: 57, 88, or 89.

In some embodiments, the modified cell of any of embodiments 1-16, wherethe modified cell comprises an isolated zinc finger nuclease (ZFN)comprising: a first zinc finger protein (ZFP) binding to a first targetsite on a T cell receptor alpha constant (TRAC) gene (or nucleic acidsequence), the first ZFP comprising three or more zinc finger domains; asecond ZFP binding to a second target site in the TRAC gene, the secondZFP comprising three or more zinc finger domains; and a cleavage domain.In some instances, the first ZFP comprising amino acid sequences SEQ IDNOS.: 278, 77, 80, 79, 78, and 87 ordered from a N-terminal of the firstZFP to a C-terminal of the first ZFP, and the second ZFP comprisingamino acid sequences SEQ ID NOS.: 82, 83, 86, and 84 ordered from aN-terminal of the second ZFP to a C-terminal of the second ZFP. In otherinstances, the first ZFP comprising amino acid sequences SEQ ID NOS.:26, 25, 26, 27, and 28 ordered from the N-terminal of the first ZFP tothe C-terminal of the first ZFP, and the second ZFP comprising aminoacid sequences SEQ ID NOS.: 30, 31, 26, 32 ordered from the N-terminalof the second ZFP to the C-terminal of the second ZFP. In someinstances, the first target site comprises amino acid sequence SEQ IDNO: 81 and the second target site comprises amino acid sequence SEQ IDNO: 85. In other instances, the first target site comprises the aminoacid sequence SEQ ID NO: 29, and the second target site comprises theamino acid sequence SEQ ID NO: 33.

In some embodiments, the CD molecule is CD4, and the extracellulardomain of the CAR comprises amino acid sequence ID: 58, 90, or 91. Insome embodiments, the CD molecule is CD4, and the extracellular domainof the CAR comprises amino acid sequence ID: 59, 92, or 93. In someembodiments, the CD molecule is CD5, and the extracellular domain of theCAR comprises the amino acid sequence ID: 94, 95, or 96.

In some embodiments, a modified cell may include a nucleic acid sequenceencoding a CAR that binds one or more subunits of the CD3/TCR complexand disruption of one or more genes associated with the CD3/TCR complex.For example, the CD3/TCR complex includes multiple subunits or chainssuch as CD3γ, CD3δ, CD3ε, TCRα, and TCRβ. In certain embodiments, anextracellular domain of the CAR binds CD3 subunits (e.g., CD3γ, CD3δ,and CD3ε subunits), and the modified cell includes a reduced amount orno expression of TRAC. In some instances, the extracellular domain ofthe CAR includes amino acid sequence SEQ ID NO: 57, 58, 59, or 95. Insome instances, the modified cell includes a zinc finger nucleasetargeting TRAC and includes a reduced amount or no expression of TRAC.

In some embodiments, the method of preparing the modified cell describedabove may include introducing the nucleic acid sequence encoding the CARto a cell to obtain the modified cell; and disrupting the one or moreexons of the gene of the cell or the modified cell.

In some embodiments, the pharmaceutical composition comprises apopulation of the modified cells described above.

In some embodiments, the method of treating T cell leukemia may includeadministrating to a subject a therapeutically effective amount of themodified cell described above. In some embodiments, the T cell leukemiacomprises at least one of large granular lymphocytic leukemia, adultT-cell leukemia/lymphoma, or T-cell prolymphocytic leukemia.

In some embodiments, the method of treating cancer expressing the CDmolecule may include administering to a subject a therapeuticallyeffective amount of the modified cell described above.

In some embodiments, a method of reducing a number of cells that expressthe CD molecule may include disrupting one or more exons of a geneassociated with the CD molecule of cells comprising a CAR to obtaindisrupted CAR cells; and contacting cells comprising the CD moleculewith an effective amount of the disrupted CAR cells, wherein a level ofproliferation and/or survival of the disrupted CAR cells is increased ascompared to the CAR cells. In some embodiments, the disrupted CAR cellsare the modified cells described above.

In some embodiments, a method of reducing the number of cells thatexpress the CD molecule may include contacting the cells with aneffective amount of the modified cell described above.

In some embodiments, a method of inhibiting proliferation or activity ofcells that express the CD molecule may include contacting the cells withan effective amount of the modified cells described above.

Cancers that may be treated include tumors that are not vascularized, ornot yet substantially vascularized, as well as vascularized tumors. Thecancers may include non-solid tumors (such as hematological tumors, forexample, leukemias and lymphomas) or may include solid tumors. Types ofcancers to be treated with the CARs of the disclosure include, but arenot limited to, carcinoma, blastoma, and sarcoma, and certain leukemiaor lymphoid malignancies, benign and malignant tumors, and malignancies,e.g., sarcomas, carcinomas, and melanomas. Adult tumors/cancers andpediatric tumors/cancers are also included.

Hematologic cancers are cancers of the blood or bone marrow. Examples ofhematological (or hematogenous) cancers include leukemias, includingacute leukemias (such as acute lymphocytic leukemia, acute myelocyticleukemia, acute myelogenous leukemia and myeloblastic, promyelocytic,myelomonocytic, monocytic and erythroleukemia), chronic leukemias (suchas chronic myelocytic (granulocytic) leukemia, chronic myelogenousleukemia, and chronic lymphocytic leukemia), polycythemia vera,lymphoma, Hodgkin's disease, non-Hodgkin's lymphoma (indolent and highgrade forms), multiple myeloma, Waldenstrom's macroglobulinemia, heavychain disease, myelodysplastic syndrome, hairy cell leukemia andmyelodysplasia.

Solid tumors are abnormal masses of tissue that usually do not containcysts or liquid areas. Solid tumors can be benign or malignant.Different types of solid tumors are named for the type of cells thatform them (such as sarcomas, carcinomas, and lymphomas). Examples ofsolid tumors, such as sarcomas and carcinomas, include fibrosarcoma,myxosarcoma, liposarcoma, chondrosarcoma, osteosarcoma, and othersarcomas, synovioma, mesothelioma, Ewing's tumor, leiomyosarcoma,rhabdomyosarcoma, colon carcinoma, lymphoid malignancy, pancreaticcancer, breast cancer, lung cancers, ovarian cancer, prostate cancer,hepatocellular carcinoma, squamous cell carcinoma, basal cell carcinoma,adenocarcinoma, sweat gland carcinoma, medullary thyroid carcinoma,papillary thyroid carcinoma, pheochromocytomas sebaceous glandcarcinoma, papillary carcinoma, papillary adenocarcinomas, medullarycarcinoma, bronchogenic carcinoma, renal cell carcinoma, hepatoma, bileduct carcinoma, choriocarcinoma, Wilms' tumor, cervical cancer,testicular tumor, seminoma, bladder carcinoma, melanoma, and CNS tumors(such as a glioma (such as brainstem glioma and mixed gliomas),glioblastoma (also known as glioblastoma multiforme) astrocytoma, CNSlymphoma, germinoma, medulloblastoma, Schwannoma craniopharyogioma,ependymoma, pinealoma, hemangioblastoma, acoustic neuroma,oligodendroglioma, menangioma, neuroblastoma, retinoblastoma and brainmetastases).

For example, renal cell cancer is one of the common malignant neoplasms.The treatment of patients with early-stage renal cell carcinoma canachieve a five-year survival rate of 90% through surgical resection.However, the advanced patients with advanced stage of diffusion andmetastasis have a five-year survival rate of only about 10%, ref(National Cancer Institute: SEER Stat Fact Sheets: Kidney and RenalPelvis Cancer. Bethesda, Md.: National Cancer Institute. Availableonline. Last accessed Nov. 2, 2017). Pancreatic cancer is a malignanttumor of the digestive tract that is very malignant and difficult todiagnose and treat. Although medical technology has been greatlyimproved in the past two decades, there are still many problems in thediagnosis and treatment of pancreatic cancer. Due to the low initialdiagnosis, pancreatic cancer often has metastases at the time of itsdiscovery. Therefore, less than 20% of patients with surgical resectionand an average of 5 years of survival of less than 10%. (American CancerSociety: Cancer Facts and Figures 2018. Atlanta, Ga.: American CancerSociety, 2018. Available online. Last accessed Jan. 5, 2018). Urothelialcancer is cancer that has evolved from urothelial cells in the urinarysystem and is a relatively rare malignancy. Although early diagnosisrate is high, and early treatment is effective, urothelial carcinoma isstill a kind of malignant tumor with high recurrence, easy progress, andpoor prognosis. Endometrial cancer refers to a group of epithelialmalignancies originating in the endometrium. Endometrial cancer is oneof the three major malignant tumors in the female reproductive tract.The 5-year survival rate of early patients is 62%-84%, but the efficacyof the patients in the late stage is poor. Breast cancer is a commonmalignant tumor, frequent in women, the incidence is high, due to thecontinuous improvement of medical means, breast cancer survivalopportunities have been significantly improved, five-year survival canreach 90%. But for the triple negative breast cancer, treatment is stillvery tricky, strong invasion of tumor cells, the prognosis is poor.Prostate cancer is the most common cancer of the male reproductivesystem, mostly male elderly patients, is the second largest fatal cancerin the United States, according to statistics, 5-year survival of earlyprostate cancer can reach 90%, but advanced prostate cancer Patients5-year survival rate of only 30%. Esophageal cancer is cancer arisingfrom the esophagus, the incidence of esophageal cancer has risen inrecent decades. The main reason for the poor prognosis is that mostpatients are often already locally advanced or have had distantmetastases when diagnosed. Most ovarian cancer patients (60%) arediagnosed with the distant-stage disease, for which 5-year survival is29%. The overall 5-year relative survival rate for ovarian cancer is low(47%). Colorectal cancer is a common malignant tumor. In addition togenetic factors, colorectal cancer is closely related to high fat, highprotein, and low fiber dietary habits. The incidence of colorectalcancer in countries such as the United States is high, and the 5-yearrelative survival rate is about 60%. In summary of the current status ofthese cancers, it appears that the treatment of cancer is still a longway to go and there is still an urgent need to develop new methods fortreating these cancers.

The cells activated and expanded as described herein may be utilized inthe treatment and prevention of diseases that arise in individuals whoare immunocompromised. In particular, the engineered cells of thepresent disclosure are used in the treatment of cancer. In certainembodiments, the cells of the present disclosure are used in thetreatment of patients at risk for developing cancer. Thus, the presentdisclosure provides methods for the treatment or prevention of cancercomprising administering to a therapeutically effective amount of themodified T cells of the present disclosure.

The modified T cells of the present disclosure may be administeredeither alone or as a pharmaceutical composition in combination withdiluents and/or with other components such as IL-2 or other cytokines orcell populations. Briefly, pharmaceutical compositions of the presentdisclosure may include a modified T cell population as described herein,in combination with one or more pharmaceutically or physiologicallyacceptable carriers, diluents or excipients. Such compositions mayinclude buffers such as neutral buffered saline, phosphate bufferedsaline and the like; carbohydrates such as glucose, mannose, sucrose ordextrans, mannitol; proteins; polypeptides or amino acids such asglycine; antioxidants; chelating agents such as EDTA or glutathione;adjuvants (e.g., aluminum hydroxide); and preservatives. Compositions ofthe present disclosure are preferably formulated for intravenousadministration.

Pharmaceutical compositions of the present disclosure may beadministered in a manner appropriate to the disease to be treated (orprevented). The quantity and frequency of administration will bedetermined by such factors as the condition of the patient, and the typeand severity of the patient's disease, although appropriate dosages maybe determined by clinical trials.

When “an immunologically effective amount”, “an anti-tumor effectiveamount”, “a tumor-inhibiting effective amount”, or “therapeutic amount”is indicated, the precise amount of the compositions of the presentdisclosure to be administered can be determined by a physician withconsideration of individual differences in age, weight, tumor size,extent of infection or metastasis, and condition of the patient(subject). It can be stated that a pharmaceutical composition comprisingthe T cells described herein may be administered at a dosage of 104 to109 cells/kg body weight, preferably 105 to 106 cells/kg body weight,including all integer values within those ranges. T cell compositionsmay also be administered multiple times at these dosages. The cells canbe administered by using infusion techniques that are commonly known inimmunotherapy (see, e.g., Rosenberg et al., New Eng. J. of Med.319:1676, 1988). The optimal dosage and treatment regime for aparticular patient can readily be determined by one skilled in the artof medicine by monitoring the patient for signs of disease and adjustingthe treatment accordingly.

In certain embodiments, it may be desired to administer activated Tcells to a subject and then subsequently redraw the blood (or haveapheresis performed), collect the activated and expanded T cells, andreinfuse the patient with these activated and expanded T cells. Thisprocess can be carried out multiple times every few weeks. In certainembodiments, T cells can be activated from blood draws of from 10 cc to400 cc. In certain embodiments, T cells are activated from blood drawsof 20 cc, 30 cc, 40 cc, 50 cc, 60 cc, 70 cc, 80 cc, 90 cc, or 100 cc.Not to be bound by theory, using this multiple blood draw/multiplereinfusion protocols, may select out certain populations of T cells.

The administration of the pharmaceutical compositions described hereinmay be carried out in any convenient manner, including by aerosolinhalation, injection, ingestion, transfusion, implantation ortransplantation. The compositions described herein may be administeredto a patient subcutaneously, intradermally, intratumorally,intranodally, intramedullary, intramuscularly, by intravenous (i. v.)injection, or intraperitoneally. In some embodiments, the T cellcompositions of the present disclosure are administered to a patient byintradermal or subcutaneous injection. In another embodiment, the T cellcompositions of the present disclosure are preferably administered byi.v. injection. The compositions of T cells may be injected directlyinto a tumor, lymph node, or site of infection.

In certain embodiments of the present disclosure, cells activated andexpanded using the methods described herein, or other methods known inthe art where T cells are expanded to therapeutic levels, areadministered to a patient in conjunction with (e.g., before,simultaneously or following) any number of relevant treatmentmodalities, including but not limited to treatment with agents such asantiviral therapy, cidofovir and interleukin-2, Cytarabine (also knownas ARA-C) or natalizumab treatment for MS patients or efalizumabtreatment for psoriasis patients or other treatments for PML patients.In further embodiments, the T cells of the present disclosure may beused in combination with chemotherapy, radiation, immunosuppressiveagents, such as cyclosporin, azathioprine, methotrexate, mycophenolate,and FK506, antibodies, or other immunoablative agents such as CAM PATH,anti-CD3 antibodies or other antibody therapies, cytoxin, fludaribine,cyclosporin, FK506, rapamycin, mycophenolic acid, steroids, FR901228,cytokines, and irradiation. These drugs inhibit either the calciumdependent phosphatase calcineurin (cyclosporine and FK506) or inhibitthe p70S6 kinase that is important for growth factor induced signaling(rapamycin). (Liu et al., Cell 66:807-815, 1991; Henderson et al., Immun73:316-321, 1991; Bierer et al., Curr. Opin. Immun 5:763-773, 1993;). Insome embodiments, the cell compositions of the present disclosure areadministered to a patient in conjunction with (e.g., before,simultaneously or following) bone marrow transplantation, T cellablative therapy using either chemotherapy agents such as, fludarabine,external-beam radiation therapy (XRT), cyclophosphamide, or antibodiessuch as OKT3 or CAMPATH. In other embodiments, the cell compositions ofthe present disclosure are administered following B-cell ablativetherapy such as agents that react with CD20, e.g., Rituxan. For example,in some embodiments, subjects may undergo standard treatment with highdose chemotherapy followed by peripheral blood stem celltransplantation. In certain embodiments, following the transplant,subjects receive an infusion of the expanded immune cells of the presentdisclosure. In other embodiments, expanded cells are administered beforeor following surgery.

The dosage of the above treatments to be administered to a patient willvary with the precise nature of the condition being treated and therecipient of the treatment. The scaling of dosages for humanadministration can be performed according to art-accepted practices by aphysician depending on various factors.

Additional information on the methods of cancer treatment usingengineered or modified T cells is provided in U.S. Pat. No. 8,906,682,incorporated by reference in its entirety.

Some embodiments relate to an in vitro method for preparing modifiedcells. The method may include obtaining a sample of cells from thesubject. For example, the sample may include T cells or T cellprogenitors. The method may further include transfecting the cells witha DNA encoding at least a CAR, culturing the population of CAR cells exvivo in a medium that selectively enhances proliferation ofCAR-expressing T cells. In some embodiments, the sample is acryopreserved sample. In some embodiments, the sample of cells is fromumbilical cord blood.

In some embodiments, the sample of cells is a peripheral blood samplefrom the subject. In some embodiments, the sample of cells is obtainedby apheresis. In some embodiments, the sample of cells is obtained byvenipuncture. In some embodiments, the sample of cells is asubpopulation of T cells. In some embodiments, the genes of the CARcells associated with an endogenous T cell receptor and/or endogenousHLA are disrupted such that immunogenicity of the CAR cells is reduced.

Some embodiments relate to a method of enhancing T cell response ortreatment of cancer, the method comprising: providing a first group of Tcells and a second group of T cells, the first group of T cellscomprising a TCR that is derived from spontaneously occurringtumor-specific T cells in a subject or a modified TCR; introducing anucleic acid sequence encoding an antigen that the TCR recognizes,obtaining antigen T cells; administrating the first group of T cells toa subject; and administrating the antigen T cells to the subject,wherein the administrating operations are performed simultaneously orare performed sequentially in the order above or a different order.

In some embodiments, the modified TCR is derived from spontaneouslyoccurring tumor-specific T cells in patients. In some embodiments, themodified TCR binds to a tumor antigen. In some embodiments, the tumorantigen comprises CEA, gp100, MART-1, p53, MAGE-A3, or NY-ESO-1. In someembodiments, the modified TCR comprises TCRγ and TCRδ Chains or TCRα andTCRβ chains. In some embodiments, a T cell clone that expresses a TCRwith high affinity for the target antigen may be isolated. In certainembodiments, tumor-infiltrating lymphocytes (TILs) or peripheral bloodmononuclear cells (PBMCs) may be cultured in the presence ofantigen-presenting cells (APCs) pulsed with a peptide representing anepitope known to elicit a dominant T cell response when presented in thecontext of a defined HLA allele. High-affinity clones may be thenselected on the basis of MHC-peptide tetramer staining and/or theability to recognize and lyse target cells pulsed with low titratedconcentrations of cognate peptide antigen. After the clone has beenselected, the TCRα and TCRβ chains or TCRγ and TCRδ Chains areidentified and isolated by molecular cloning. For example, for TCRα andTCRβ chains, the TCRα and TCRβ gene sequences are then used to generatean expression construct that ideally promotes stable, high-levelexpression of both TCR chains in human T cells. The transduction vehicle(e.g., a gammaretrovirus or lentivirus) may be then generated and testedfor functionality (antigen specificity and functional avidity) and usedto produce a clinical lot of the vector. An aliquot of the final productis then used to transduce the target T cell population (generallypurified from patient PBMCs), which is expanded before infusion into thepatient.

Various methods may be implemented to obtain genes encodingtumor-reactive TCR. More information is provided in Kershaw et al., ClinTransl Immunology. 2014 May; 3(5): e16. In some embodiments, specificTCR can be derived from spontaneously occurring tumor-specific T cellsin patients. Antigens included in this category include the melanocytedifferentiation antigens MART-1 and gp100, as well as the MAGE antigensand NY-ESO-1, with expression in a broader range of cancers. TCRsspecific for viral-associated malignancies can also be isolated, as longas viral proteins are expressed by transformed cells. Malignancies inthis category include liver and cervical cancer, associated withhepatitis and papilloma viruses, and Epstein-Barr virus-associatedmalignancies. In some embodiments, target antigens of the TCR mayinclude CEA (e.g., for colorectal cancer), gp100, MART-1, p53 (e.g., forMelanoma), MAGE-A3 (e.g., Melanoma, esophageal and synovial sarcoma),NY-ESO-1 (e.g., for Melanoma and sarcoma as well as Multiple myelomas).

EXEMPLARY EMBODIMENTS

The following are exemplary embodiments:

1. A modified cell comprising a nucleic acid sequence encoding achimeric antigen receptor (CAR) and a disruption of one or more exons ofa gene associated with a cluster of differentiation molecule (CD),wherein an extracellular domain of the CAR recognizes the CD molecule.

2. The modified cell of embodiment 1, where the gene associated with theCD molecule comprises CD2, CD3/TCR, CD4, CD5, CD7, CD8, or CD52 genes.

3. The modified cell of embodiment 1 or 2, wherein the modified cell isa CAR NK cell or a CAR T cell.

4. The modified cell of any one of embodiments 1-3, wherein the CARcomprises the extracellular domain, a transmembrane domain, and anintracellular domain, wherein the extracellular domain binds an antigen.

5. The modified cell of any one of embodiments 1-4, wherein theintracellular domain comprises a costimulatory signaling region thatcomprises an intracellular domain of a costimulatory molecule selectedfrom the group consisting of CD27, CD28, 4-1BB, OX40, CD30, CD40, PD-1,ICOS, lymphocyte function-associated antigen-1 (LFA-1), CD2, CD7, LIGHT,NKG2C, B7-H3, and any combination thereof.

6. The modified cell of any one of embodiments 1-5, wherein the modifiedcell has a disrupted endogenous gene associated with a biosynthesis ortransportation pathway of CD2, CD3/TCR, CD4, CD5, CD7, CD8, or CD52genes.

7. The modified cell of any one of embodiments 1-6, wherein the geneassociated with the CD molecule is CD3/TCR gene, and the modified cellhas a reduced amount of at least one of TCR subunits, or at least one ofCD3γ, CD3δ, CD3ε, or CD3ζ subunits.

8. The modified cell of any one of embodiments 1-7, wherein the geneassociated with the CD molecule is CD3/TCR gene, and the modified cellhas a reduced amount of at least one of TRAC, CD3γ, CD3δ, or CD3εsubunits.

9. The modified cell of any one of embodiments 1-7, wherein the geneassociated with the CD molecule is CD3/TCR gene, and the modified cellhas a reduced expression of TRAC, CD3γ, CD3δ, and CD3ε subunits.

10. The modified cell of any one of embodiments 1-9, wherein theextracellular domain binds CD3 or TCR, and the modified cell elicits areduced amount or no T cell response caused by another modified cell ina subject as compared to the T cell response elicited by a cell thatcomprises the CAR of which the extracellular domain binds CD3 or TCR anddoes not have a disruption of one or more exons of the gene associatedwith CD3/TCR.

11. The modified cell of any one of embodiments 1-10, wherein theextracellular domain of the CAR comprises amino acid sequence SEQ ID NO:57.

12. The modified cell of any one of embodiments 1-11, wherein theextracellular domain of the CAR comprises amino acid sequence ID NO: 88and/or 89.

13. The modified cell of any one of embodiments 1-12, wherein the geneassociated with the CD molecule is CD3/TCR gene, and the extracellulardomain of the CAR comprises amino acid sequence SEQ ID NO: 57, 88, or89.

14. The modified cell of any one of embodiments 1-13, wherein the CDmolecule is CD4, and the extracellular domain of the CAR comprises theamino acid sequence ID: 58, 90, or 91.

15. The modified cell of any one of embodiments 1-14, wherein the CDmolecule is CD4, and the extracellular domain of the CAR comprises theamino acid sequence ID: 59, 92, or 93.

16. The modified cell of any one of embodiments 1-15, wherein the CDmolecule is CD5, and the extracellular domain of the CAR comprises theamino acid sequence ID: 94, 95, or 96.

17. The modified cell of any one of embodiments 1-16, where the modifiedcell comprises an isolated zinc finger nuclease (ZFN) comprising: afirst zinc finger protein (ZFP) binding to a first target site in aT-cell receptor alpha constant (TRAC) molecule, the first ZFP comprisingthree or more zinc finger domains; a second ZFP binding to a secondtarget site in the TRAC gene, the second ZFP comprising three or morezinc finger domains; and a cleavage domain, wherein: the first ZFPcomprising amino acid sequences SEQ ID NOS.: 278, 77, 80, 79, 78, and 87ordered from a N-terminal of the first ZFP to a C-terminal of the firstZFP, and the second ZFP comprising amino acid sequences SEQ ID NOS.: 82,83, 86, and 84 ordered from a N-terminal of the second ZFP to aC-terminal of the second ZFP, the first ZFP comprising amino acidsequences SEQ ID NOS.: 26, 25, 26, 27, and 28 ordered from theN-terminal of the first ZFP to the C-terminal of the first ZFP, and thesecond ZFP comprising amino acid sequences SEQ ID NOS.: 30, 31, 26, 32ordered from the N-terminal of the second ZFP to the C-terminal of thesecond ZFP, the first target site comprising amino acid sequence SEQ IDNO: 81, and the second target site comprising amino acid sequence SEQ IDNO: 85, or the first target site comprising amino acid sequence SEQ IDNO: 29, and the second target site comprising amino acid sequence SEQ IDNO: 33.

18. A method of preparing the modified cell of any of embodiments 1-17,the method comprising: introducing the nucleic acid sequence encodingthe CAR to a cell to obtain the modified cell; and disrupting the one ormore exons of the gene of the cell or the modified cell.

19. A pharmaceutic composition comprising a population of the modifiedcells of any one of embodiments 1-17.

20. A method of treating T-cell leukemia, the method comprising:

administering to a subject a therapeutically effective amount of themodified cell of any one of embodiments 1-17, wherein the T-cellleukemia comprises at least one of large granular lymphocytic leukemia,adult T-cell leukemia/lymphoma, or T-cell prolymphocytic leukemia.

21. A method of treating cancer expressing a CD molecule, the methodcomprising: administering to a subject a therapeutically effectiveamount of the modified cell of any one of embodiments 1-17.

22. A method of reducing a number of cells that express a CD molecule,the method comprising: disrupting one or more exons of a gene associatedwith a CD molecule of cells comprising a CAR to obtain disrupted CARcells; and contacting cells comprising the CD molecule with an effectiveamount of the disrupted CAR cells, wherein a level of proliferationand/or survival of the disrupted CAR cells is increased as compared tothe CAR cells.

23. The method of embodiment 22, wherein the disrupted CAR cells are themodified cell of any of embodiments 2-17.

24. A method of reducing a number of cells that express a CD molecule,the method comprising: contacting the cells with an effective amount ofthe modified cell of any of embodiments 1-17.

25. A method of inhibiting proliferation or activity of cells thatexpress a CD molecule, the method comprising: contacting the cells withan effective amount of the modified cell of any of embodiments 1-17.

26. A method of enhancing T cell response or treatment of cancer, themethod comprising: providing a first group of T cells and a second groupof T cells; introducing a first nucleic acid sequence encoding CAR ormodified TCR to a first group of T cells, obtaining CAR or modified TCRT cells; introducing a second nucleic acid sequence encoding an antigenthat the CAR or the modified TCR recognizes, obtaining antigen T cells;administrating the CAR or modified TCR T cells to a subject; andadministrating the antigen T cells to the subject, wherein theadministrating operations are performed simultaneously or are performedsequentially in the order above or a different order.

27. A method of enhancing T cell response or treatment of cancer, themethod comprising: providing a first group of T cells and a second groupof T cells, the first group of T cells comprising a TCR that is derivedfrom spontaneously occurring tumor-specific T cells in a subject or amodified TCR; introducing a nucleic acid sequence encoding an antigenthat the TCR recognizes, obtaining antigen T cells; administrating thefirst group of T cells to a subject; and administrating the antigen Tcells to the subject, wherein the administrating operations areperformed simultaneously or are performed sequentially in the orderabove or a different order.

28. The method of embodiment 27, wherein the TCR binds to a tumorantigen.

29. The method of embodiment 28, wherein the tumor antigen comprisesCEA, gp100, MART-1, p53, MAGE-A3, or NY-ESO-1.

30. The method of embodiment 27, wherein the TCR comprises TCRγ and TCRδChains or TCRα and TCRβ chains, or a combination thereof.

31. The method of any of embodiments 26 and 26, wherein the expressionof antigen is regulated by an inducible expression system.

32. The method of 31, wherein the inducible expression system isrTTA-TRE, which increases or activates the expression of the antigen.

33. The method of 31, wherein the antigen T cells comprise a nucleicacid sequence encoding a suicide gene.

34. The method of 31, wherein the suicide gene is an HSV-TK system.

EXAMPLES

The present disclosure is further described by reference to thefollowing examples.

These examples are provided for purposes of illustration only and arenot intended to be limiting unless otherwise specified. Thus, thepresent disclosure should in no way be construed as being limited to thefollowing examples, but rather, should be construed to encompass any andall variations which become evident as a result of the teaching providedherein.

Expression of CAR on HEK293T & K562 Cells

Lentiviral vectors that encode a CD19 CAR or a TSHR CAR were generated(see “Chimeric Receptors Containing CD137 Signal Transduction DomainsMediate Enhanced Survival of T Cells and Increased AntileukemicEfficacy,” In Vivo Molecular Therapy vol. 17 no. 8, 1453-1464 August2009, incorporated herein by reference).

Primary T cells were obtained from patients. The obtained primary Tcells were transduced with lentiviral vectors to obtain modified Tcells. Flow-cytometry was performed and analyzed to determine theexpression of CARs in the primary T cells. Techniques related to cellcultures, construction of lentiviral vectors, and flow cytometry may befound in “Control of large, established tumor xenografts withgenetically retargeted human T cells containing CD28 and CD137 domains,”PNAS Mar. 3, 2009, vol. 106 no. 9, 3360-3365, which is incorporatedherein by reference.

T cells were cultured using a media containing anti-CD3/CD28 beads butno CD19 ECD. Cell expansion rates of both non-transduced T cells andCD19 CAR T cells were observed and shown in FIG. 1.

Stimulation and Amplification of CAR T Cells in the Presence of CD19Extracellular Domain (ECD)

The primary T cells were transduced with lentiviral vectors encoding aCD19 CAR to obtain modified T cells including CAR T cells expressinganti-CD19 (thereafter “CAR T19 cells”) on day 1. The modified T cellswere divided into two groups and cultured, respectively. CAR T19 cellsin Group 1 were cultured with anti-CD3 & CD28 beads and IL2, while CART19 cells in Group 2 were cultured with soluble CD19 (e.g.,extracellular domain (ECD) of CD19, SEQ ID: 41), anti-CD3 & CD28 beadsand IL2. For Group 2, 500,000 CAR T19 cells were cultured with 2micrograms of soluble CD19 at the starting point, and 4 micrograms ofsoluble CD19 were used after the CAR T19 cells were grown. The numbersof cells were measured, and ratios between CAR+ cells and the modified Tcell population were observed by flow cytometry. The number of CARcopies in the cell population was measured.

CAR T cells and T cells not expressing CAR were observed to havedifferent degrees of growth, for example, on 22 days. As shown in column5 of FIG. 2, copy numbers of CAR T19 cells in Group 2 was higher thanthose of Group 2 based on qPCR analysis. As shown in column 6 of FIG. 2,the ratio of CAR T19 cells and T cells in Group 2 was higher than thatof Group 1 using flow cytometry analysis. As shown in FIG. 3, thevertical axis represents anti-scFv PE, and areas in the boxes indicateCAR T19 cells. Surprisingly, in response to adding of CD19 ECD in themedia, both non-transduced T cells and CD19 CAR T cells exhibited noapparent increases in cell expansion as compared to culturing withoutCD19 ECD during the early stage, which is from about day 3 to day 10.After this stage, cell expansion rates of CD19 CAR T cells increased ata higher rate than those cultured without the CD19 ECD. These resultsdemonstrated that CD19 stimulated or enhanced long-term maintenance ofCAR T19 cells in vitro while showing no apparent enhancement forshort-term maintenance (e.g., less than 10 days).

Stimulation and Amplification of CAR T Cell in Presence of TSHR ECD

Primary T cells were transduced with lentiviral vectors encoding a TSHRCAR to obtain modified T cells including CAR T cells expressinganti-TSHR (thereafter “CAR T-TSHR cells”). The modified T cells werefrozen and stored for 30 days. Techniques related to freezing T cellsand thawing frozen T cells may be found in Levine et al., MolecularTherapy—Methods & Clinical Development, Molecular Therapy, Vol 4, Mar.17, 2017.

The modified Tcells were thawed and divided into two groups andcultured, respectively. CAR T-TSHR cells in Group 1 were cultured withanti-CD3 & CD28 beads and IL2 for 10 days, while CAR T-TSHR cells inGroup 2 were cultured with various concentrations of soluble TSHR (e.g.,extracellular domain of TSHR, SEQ ID: 34), anti-CD3 & CD28 beads andIL2. For Group 2, 500,000 CAR T-TSHR cells were cultured with 10, 125,500 ng/ml of soluble TSHR ECD for 14 days. The T cell population wasobserved by flow cytometry (FIGS. 8 and 9), and cellular morphology ofthe T cell population was observed under microscopes (FIG. 10).

As shown in FIG. 8, SSC-A dispersible FSC low population decreased withincreasing concentrations of TSHR ECD. As shown in FIG. 8, the ratio(P1) of CAR+ cells and the CAR T-TSHR cells significantly increased when500 ng/ml of soluble TSHR ECD was added to the cells in Group 2. Asshown in FIGS. 9 and 10, as the proportion of added antigen (TSHR-ECD)increased, cell debris decreased, which indicated that the cells weremaintained in a better state than culturing without TSHR ECD. MFI(median fluorescence intensity) refers to the median fluorescentposition of the population of cells and is calculated as a numericalvalue. As shown in FIG. 10, under 500 ng antigen stimulation, the CARfluorescence (lower horizontal axis) moved to the right side of thepopulation of cells. The proportion of CAR positive cells increased, theintensity increased, and the MFI value increased. These resultsdemonstrated that TSHR stimulated or enhanced long-term maintenance ofCAR T-TSHR cells in vitro.

Observation of T Cell Phenotype

T cell phenotypes were further observed. On day 30 after the startingpoint, the ratio of CAR T19 cells and Tcells in Group 2 continued torise (See P4 boxes in FIG. 4). Memory cell marker CD62L on CAR+ andCAR-cells were analyzed to determine phenotypes of cultured T cellpopulation. In CAR T19 cells of Group 2, the entire or majority cells ofthe T cell population showed the phenotype of memory cells (e.g., CD62Lhi). The upper diagram of FIG. 5 showed CAR+cell analysis, and lowerdiagram showed CAR-cell analysis. These data indicated that CD19 inducedCAR T cells to produce the phenotype of memory T cells.

Function Analysis of CAR T19 in Group 1 and Group 2

CAR T19 cells of Group 1 and Group 2 were cultured for about one tothree weeks using the protocols described above, respectively. CAR T19cells were then washed and placed into cultures without CD19. These CART19 cells were co-cultured with K562-CD19 (E:T 1:1 or 1:10). After 24hours, 48 hours, and 72 hours, supernatant of the cultures werecollected, and IFN-gamma released by the cells were measured todetermine functions of CAR T19 cells.

IFN-gamma was observed for both Group 1 and Group 2. As illustrated inFIG. 6, after 24 hours, IFN-gamma in Group 2 is significantly higherthan those of Group 1. It seemed that CAR T cells in Group 1 were in alower energy consumption state (e.g., memory T cell state), and it tooka certain amount of time for the cells to become active (See FIG. 6).These data indicated that culturing CAR T cells with CD19 enhanced theCAR T cells' ability to release IFN-gamma.

Impact of CD19 Removal on CAR T19 Cells

CAR T19 cells were cultured with CD19 for over 15 days and then weredivided into Group 3 and Group 4. CAR T19 cells in Group 3 werecontinuously cultured with soluble CD19, while CAR T19 cells in Group 4were cultured without CD19. As shown in FIG. 7 (e.g., Day 27), numbersof CAR+ cells in Group 4 was relatively lower than those of Group 3.These data indicated that CD19 help to maintain the presence of CAR T19cells.

Construction of CARs and Additional Amino Acids of Hinge DomainPromoting Expansion of CAR T Cells

Various CARs (A, B, C, and D) were constructed by linking a signalpeptide (SEQ ID NO: 38), antigen-specific single-chain variable fragment(scFv) (SEQ ID NO: 55 or 21), hinge domain (SEQ ID NOs: 68, 69, 70, or71), a transmembrane domain (SEQ ID NO: 72, 73, 74, or 75), one or moreco-stimulation domains (SEQ ID NO: 3), CD3-i (SEQ ID NO: 40), and EGFP,respectively (See FIGS. 12 and 13).

Primary T cells were obtained from the peripheral blood of volunteers.The magnetic beads negative selection was performed using Pan-T kit fromMiltenyi Biotec, Inc. to collect T cells from the peripheral blood. Onthe second day after primary T cell isolation, the collected T cellswere infected with lentivirus containing A, B, C, and D CARs,respectively (i.e., Lenti-CARs-IRES-EGFP) to prepare CAR T cells.

On the 14th day after infection, 15,000 CAR T cells of each group werecollected, and cultured with 1000 ng/ml CD 19 antigen (i.e., recombinanthuman CD19 protein. After 15 days of stimulation, the concentration ofCD19 was changed to 400 ng/ml. After 20 days of stimulation, theconcentration of CD19 was changed to 200 ng/ml and maintained untilabout 130 days.

The expression of CARs and cell morphology were observed using flowcytometry on day-2, day 15 (FIGS. 14-17), day 17 (FIG. 20), day 65 andday 130 at the beginning of the stimulus. Combination of anti-F(ab2)′—biotin and PE-streptavidin antibodies were used to detect CARexpression. The FITC channel was used to detect the expression of EGFP,and parameters for detection of cell debris and cell survival rates wereSSC/FSC.

At 130 days, K562-RFP-CD19, K562-RFP, and Nalm6 cells were used toexamine the function of CAR Tcells maintained by the protocol describedabove. Among them, K562-RFP-CD19 and Nalm6 were CD19 positive cells,while K562-RFP was CD19 negative cells. CAR T cell function wasevaluated by measuring the killing effect (e.g., red fluorescence) andcytokine release (e.g., IFN-g). And the copy number of CAR molecules weexamined.

FIGS. 14 and 15 show flow cytometric results of CAR T cells before orafter and with or without CD19 co-culturing. Changes of EGFP expressionin CAR T cells were observed. CAR molecules were EGF-bearingCAR-IRES-EGFP. Accordingly, after CARs were stimulated, greenfluorescence was stronger as compared with unstimulated CARs. As shownin FIGS. 14 and 15, the intensity of EGFP expression in P8 boxes wasfound on the horizontal axis of EGFP-FITC. FIG. 14 shows thepre-stimulus (group B/D) and the group without parallel stimulation(group A/C), and FIG. 15 shows the after-stimulus (group B/D) and thegroup with parallel stimulation (group A/C).

FIGS. 16 and 17 show further flow cytometric results of CAR T cellsbefore or after and with or without CD19 co-culturing. Changes of EGFPexpression in CAR T cells were observed. CAR molecules were EGF-bearingCAR-IRES-EGFP. Accordingly, after CARs were stimulated, greenfluorescence was stronger as compared with unstimulated CARs. As shownin FIGS. 16 and 17, the vertical axis is CAR-PE, and the horizontal axisis EGFP-FITC, and the CAR molecule was s EGFP-bearing (e.g.,CAR-IRES-EGFP). Further, the intensity of CAR+EGFP+expression was shownin Q3-UR (upper left corner) boxes. FIG. 16 further shows the phenotypeafter receiving CD19 stimulation (B/D group) and in parallel culturewithout stimulation (A/C group). FIG. 20, similar to FIGS. 16 and 17,shows flow cytometric results of Groups A and D on Day 17. These resultsshow that the proportion of CAR+EGFP+cells increase and these cellscontinue to grow.

These results demonstrate that CD19 stimulation can be used to maintainanti-CD19 CAR T cell growth (See FIGS. 12 and 13), CD19 stimulation canenrich or specifically stimulate T cells of CAR+(See FIGS. 14-16), andin Vitro CD19 protein can be used to activate T cells to continuouslygrow and enrich CAR-positive cells.

FIGS. 18 and 19 show that CD4/CD8 phenotypic changes in CAR T cells.These two pictures show the same experiment, that is, the change of CD8and CD4 ratio of CAR T cells with or without a different hinge before orafter stimulation with CD19. It was previously observed that CAR T cellscultured in the presence of antigen-persistence gradually change topredominately CD4 cells. FIG. 18 shows flow cytometric results of theparallel untreated CAR T cell phenotype in A and C groups. The verticalaxis is CD8, and the horizontal axis is CD4. The upper left area isCD8+T cells, and the lower right area is CD4+T cells. FIG. 19 is flowcytometric results of CD19-stimulated cells and shows an increasedpercentage of CD4 cells. These results indicate that anti-CD19 and otherantigen stimulation can change the composition of T cells.

FIG. 21 shows a killing assay on CAR T cells of group D, which had beencultured using CD19 protein for 130 days. K562-RFP/K562 CD19-RFP cellswere co-cultured with the CAR T cells, respectively, and their killingeffects were examined on day 130. As shown in FIG. 21, the right threecolumns showed the significant killing of K562 CD19-RFP cells at 1:1 and10:1, as shown in the box. Given the background stimulation of CD19 onCAR T cells, the CD19 protein was removed prior to the start of theexperiment and replaced with CD19-free broth. These results of FIG. 21demonstrate that the CAR T cells co-cultured with CD19 maintained thekilling function. Further, Interferon gamma (IFN-g) release by these CART cells of group D was examined. FIG. 22 shows flow cytometry results ofIFN-g release of CAR T cells of group D, and copy numbers werecalculated. The CAR T cells of group D were co-cultured with the CD19positive cell (K562-RFP-CD19, nalm-6) and cytokine release was measured.As shown in FIG. 22, CAR T cells co-cultured using CD19 for 130 daysreleased IFN-g against CD19+cells (See the left panel of FIG. 22. On thetop right panel, flow cytometric results indicated CAR expression ofthese CAR T cells. The horizontal axis is FITC for detection of EGFP,the vertical axis is PE for detection of CAR molecules, and Q3-UR showsCAR+EGFP+cell ratio. The bottom right panel shows the number of copiesof the CAR T cells, which were measured using qPCR. These resultsdemonstrate that CD19 stimulated CAR T cells released IFN-g againstCD19+ cells. Further, these CAR T cells maintained the CAR-positive cellphenotype on day 130. Also, CD19 continuously stimulated CAR T cells togrow at day 130. While CAR+closely reached full positive, the copynumber was less than 4.

CAR-Jurkat T Cell Killing Assay

Jurkat T cells were introduced with a nucleic acid sequence encodingCD19-CAR. A killing assay was performed, and no or weak killingfunctions were observed. Further expression of T cell markers wasanalyzed. While expressing CD3, CAR-Jurkat T cells showed low expressionof CD4 and no expression of CD8. These results demonstrated thatproliferable T cells including the nucleic acid sequence encoding hTERTand/or SV40LT were better than CAR-Jurkat T cells with respect toinhibiting the growth of tumor cells.

Preparation of Modified Cells

Starting from the separation of the initial healthy human T cells(Day0), on Day1 human T cells were infected with hTERT alone, (“alone”means only this one), SV40LT alone, hTERT+SV40LT, hTERT+mouse CD19CAR,SV40LT+mouse CD19CAR, hTERT+SV40LT+mouse CD19CAR (see FIG. 23). A totalof 6 groups were tested.

The expression of CD3, CD4, CD8, CD279, mCAR was detected by FACSseveral times. And then the cells were cultured; on Day 92 the cellswere analyzed to detect mCAR (mouse CAR). On Day 92, mCAR wastransferred again. On day 95 co-culture (tumor and effector co-culture)was performed with ratios of E:T: 1:1, 3:1, 10:1:30:1. (unit millioncells)

4 h and 24 h killing effect were measured by collecting fluorescencesignals. 24 h later, supernatant (co-culture) was collected, and therelease of IFN-g was measured. m19CAR (yes) refers to the situation thatm19CAR was infected at the beginning of the infection.

FIGS. 24, 25 and 26 are fluorescence photographs showing the killingeffect of a plurality of T cells. K562-CD19 is a cell line constructedby overexpressing a CD19 protein on the surface of k562 cells (ratio ofE:T: 30:1 and 10:1). The results showed the killing effect for 24 hours.Immortalized T cells were infected with lentiviruses at 3 days inadvance such that the immortalized T cells were transferred with therat-derived CAR, allowing immortalized T cells to express CAR. Thesetransferred cells were then co-cultured with tumor cells for killing andIFN-g release measurement.

In FIG. 24, K562-CD19 alone represents k562-CD19's own cell state (onlythe tumor itself without adding other cells). In the negative control10:1, wild-type T cells and tumor cells (RK562-CD19) were co-cultured,showing no killing (ratio of E:T: 10:1). In negative control 30:1,wild-type T cells and tumor cells (RK562-CD19) were co-cultured, showingno killing (ratio of E:T: 30:1). In positive control m19CAR (1101):30:1, CAR T cells (T cells infected with mCAR) and tumor cells(RK562-CD19) were co-cultured, showing a significant proportion of thekilling (ratio of E:T: 30:1).

FIG. 25 shows effectiveness validation regarding the immortalized cells.Regarding Sv40LT alone+m19CAR (Yes) 10:1, immortalized T cells wereinfected with murine mCAR virus (transferred with sv40LT) co-culturedwith tumor cells (RK562-CD19), showing certain kill effect (ratio ofE:T: 10 Sv40lt alone+m19CAR T cell and a tumor cell. Regarding Sv40LTalone+m19CAR (Yes) 30:1, immortalized T cells were infected with themCAR virus (transferred with sv40LT) and co-cultured with tumor cells(RK562-CD19), showing good killing effect (ratio of E:T: 30:1:30Sv40lt+m19CAR T cell to and a tumor cell). Regarding Sv40LT+hTERT+m19CAR(Yes) 10:1: immortalized T cells were infected with the mouse mCAR virus(transferred with the sv40LT and hTERT) and co-cultured with tumor cells(RK562-CD19), showing little killing effect (ratio of E:T: 10:1:10Sv40LT+hTERT+m19CAR T cell and the tumor). Regarding Sv40lt+hTERT+ml9CAR (Yes) 30:1:immortalized T cells were infected with mCAR virus(transferred with both sv40LT and hTERT) and co-cultured with tumorcells (RK562-CD19), showing killing effect (ratio of E:T:10Sv40LT+hTERT+m19CAR T cell and a tumor cell).

FIG. 26 shows security validation regarding the immortalized cells.Regarding Sv40LT alone 10:1: immortalized T cells without infection ofthe CAR virus (transferred with sv40LT) were co-cultured with tumorcells (RK562-CD19), showing no killing effect (ratio of E:T: 10 Sv40LTalone T cell and a tumor cell). Regarding Sv40LT alone 30:1:immortalized T cells without infection of the CAR virus (transferredwith sv40LT) were co-cultured with tumor cells (RK562-CD19), showing nokilling effect (ratio of E:T: 30 Sv40lt alone T cell and a tumor cell).Regarding hTERT alone 10:1: immortalized T cells (transferred withhTERT) were co-cultured with the tumor cells (RK562-CD19), showing nokilling effect (ratio of E:T: 10 hTERT alone T cell and a tumor cell).Regarding hTERT alone 30:1: immortalized T cells without infection ofthe CAR virus (transferred with hTERT) were co-cultured with tumor cells(RK562-CD19), showing no killing effect (ratio of E:T: 30 hTERT alone Tcell and a tumor cell). Regarding HTERT+SV40LT 10:1: immortalized Tcells without infection of the CAR virus (transferred with hTERT andSV40LT) were co-cultured with tumor cells (RK562-CD19), showing nokilling effect (ratio of E:T: 10 hTERT+SV40LT T cell and a tumor cell).Regarding hTERT+SV401t 30:1: immortalized T cells without infection ofthe CAR virus (transferred with hTERT and SV40LT) were co-cultured withtumor cells (RK562-CD19), showing no killing effect (ratio of E:T: 30hTERT+SV40LT T cell and a tumor cell).

FIGS. 27-31 are graphs showing multiple immortalized single cellsequencing assays. The analysis showed that certain gene expressionsrelated to T cell killing functions increased, and thus the cytotoxicityof these T cells was improved. For example, the expression of GAMA wassignificantly increased in immortalized T cells compared to wild-type Tcells.

Table 1 summarizes DNA and/or protein polypeptide sequences involved inthe above experiments.

SEQ ID SEQ ID SEQ ID NO: Identifier NO: Identifier NO: Identifier 1 Ef1α28 ZFN 54 M Fokl 2 TK 29 Target DNA 55 scFv CD19 3 IRES 30 ZFN 56Prolactin (ligand) 4 rtTA 31 ZFN 57 scFv CD3 5 TRE 32 ZFN 58 scFv CD4 6hTERT 33 Target DNA 59 scFv CD4-2 7 SV40lt 34 TSHR ECD 60 CD3 antigen 8humanized CD19 CAR 35 Hinge &TM domain 61 CD4 antigen 9 humanized CD19CAR- 36 Hinge domain 62 CD5 antigen Trancate 10 humanized CD19 CAR- 37TM domain 63 CAR CD19 nucleic acid Mutation 11 CD20 CAR 38 SP 64 Group BHinge & TM domain 12 L2D8 whole sequence 39 Co-stimulatory region 65Group A Hinge & TM domain 13 LV-ef1a-kozak-TK-IRES- 40 CD3-zeta 66 GroupD Hinge & TM domain rtTA-TRE-hTERT 14 LV-ef1a-kozak-TK-IRES- 41 CD19antigen 67 Group C Hinge & TM domain rtTA-TRE-sv40LT 15 Lv-ef1α-hTERT 42FZD10 antigen 68 Group D Hinge domain 16 Lv-ef1α-L2D8-PD1-m 43 TSHRantigen 69 Group C Hinge domain 17 Lv-ef1α-L2D8-PD1-T 44 PRLR antigen 70Group B Hinge domain 18 Lv-ef1α-sv40LT 45 Muc17 antigen 71 Group A Hingedomain 19 M971-CAR CD22 car 46 GUCY2C antigen 72 Group D TM domain 20M972-CAR CD22 car 47 CD207 antigen 73 Group C TM domain 21 hCD19 scFV 48scFv FZD10 74 Group B TM domain 22 CD19 ECD 49 scFv TSHR 75 Group A TMdomain 23 Fokl W 50 scFv PRLR 76 GS linker 24 Fokl M 51 scFv Muc17 77ZFLm1 (left) F2 25 ZFN 52 scFv GUCY2C 78 ZFLm1 (left) F1 26 ZFN 53 scFvCD207 79 ZFLm1 (left) F4 27 ZFN 54 M Fokl 80 ZFLm1 (left) F3 81 ZFLm1 82ZFRm1-4 83 ZFRm1-4 (left) Re SEQ (right) F1 (right) F2 84 ZFRm1-4 85ZFRm1-4 86 ZFRm1-4 (right) F4 (right) Re SEQ (right) F3 87 ZFLm1 (left)F6 88 VL CD3 89 VH CD3 90 VL CD4-1 91 VH CD4-1 92 VL CD4-2 93 VH CD4-294 scFv CD5 95 VL CD5 96 VH CD5

The primary T cells obtained from a healthy donor were transduced withlentiviral vectors encoding a CD19 CAR (SEQ ID NO: 21) and lentiviralvectors including sequence 1 or 6 as illustrated in FIG. 1(ef1a-TK-IRES-rtTA-TRE-hTERT: SEQ ID NOs: 1, 2, 3, 4, 5, and 6 in the 5′to 3′ order or ef1a-rtTA-TRE-hTERT: SEQ ID Nos: 1, 4, 5, and 6 in the 5′to 3′ order) to obtain transduced T cells including immortalized T cellsexpressing anti-CD19 CAR (thereafter “anti-CD19 CAR proliferable Tcells”) on day one. The anti-CD19 CAR proliferable T cells were dividedinto various groups and cultured in different media: in the presence ofvarious concentrations of doxycycline (Dox), CD19 extracellular domain(ECD), and/or Ganciclovir (GCV)). In some groups, CD19 ECD (SEQ ID NO:22) was added to media (1 mg/250,000 CAR T cells), and percentages ofcells expressing CD19 CAR increased.

In group one, transduced cells were cultured in a media containing Dox(2 μg/ml) from day 1. On day 42, CD19 ECD was added to the media((500,000 CAR T cells/2 micrograms of soluble CD19). On day 90, flowcytometry analysis was performed on the transduced cells. FIG. 32 showsflow cytometry results CAR expression in immortalized T cells.

In group two, transduced cells were cultured using media containing Dox(2 μg/ml) for about 92 days and are divided into two subgroups. On day92, Dox was removed from the subgroup 1 and Dox was maintained in thesubgroup 2. Cell growth in these two subgroups was observed, and resultswere provided in FIG. 33.

In group three, transduced cells (ef1a-TK-IRES-rtTA-TRE-hTERT) werecultured using media containing Dox (2 μg/ml) and CD19 ECD (1 mg/250,000CAR T cells). On day 90, various concentrations of GCV was added to thetransduced cells. Cell growth in these two subgroups was observed, andresults were provided in FIGS. 34-36. NT represents non-transduced Tcells and continued to grow in the presence of GCV. DTT cells representtransduced T cells and grew poorly in the presence of GCV.

In group four, transduced cells were cultured with different cellconcentrations using media containing Dox (2 μg/ml) and CD19 ECD (1mg/250,000 CAR T cells). Cell growth was measured on day 90, and resultswere provided in FIGS. 37 and 38 as well as 44.

In group five, transduced cells were cultured using media containing Dox(2 μg/ml) and CD19 ECD (1 mg/250,000 CAR T cells). Killing assays onthese cells were performed on day 90, and results were provided in FIG.39.

In group six, transduced cells were introduced with TRAC-specific ZFNsconstructed to enable the site-specific introduction of mutations atTRAC gene. Various ZFNs were designed and incorporated into plasmidsvectors essentially as described in Urnov et al. (2005) Nature435(7042):646-651, Lombardo et al. (2007) Nat Biotechnol. November;25(11):1298-306, and U.S. Patent Publication 2008/0131962. The ZFNsincludes various of combinations of Zinc finger binding domains (e.g.,ZFN-left and ZFN-right binding domains), which were listed in Table 1and Table 2 as well as Table 3. The cleavage domain of the ZFNscomprised an engineered FokI cleavage domain (SEQ ID NOS.: 23, or 24).mRNA encoding a pair of ZFNs (See Table 2) was introduced into thetransduced cells to modify a target genomic locus associated with αchain of TCR. CD3 expression was measured, and results were provided inFIGS. 40-42.

Contributions of the agent (e.g., ECD CD19) and/or the proliferablemodification (e.g., hTERT) were investigated. FIG. 44 shows cell growthof various groups CAR T cells in different conditions. A: Group 1:proliferable CD19 CAR T cells (hTERT) were cultured in a mediacontaining ECD CD19 and Dox. Group 2: proliferable CD19 CAR T cells(hTERT) were cultured in a media containing Dox without ECD CD19. Group3: CD19 CAR T cells were cultured in a media without containing Dox andECD CD19. B: Group 1: CD19 CAR T cells (h19CAR) were cultured in a mediawithout containing ECD CD19 and Dox. Group 2: proliferable CD19 CAR Tcells with dual-switch (dual-switch h19CAR+dox) were cultured in a mediacontaining Dox but no ECD CD19. Group 2: proliferable CD19 CAR T cellswith dual-switch (dual-switch h19CAR+dox+cd19) were cultured in a mediacontaining Dox and ECD CD19. These results demonstrated that the agentand/or the proliferable modification contributed to long termmaintenance of CAR T cells in vitro.

TABLE 2 Target IDs of Zinc Sequence of F1 F2 F3 F4 F5 F6 finger DNA TRACgene (SEQ (SEQ (SEQ (SEQ (SEQ (SEQ binding (SEQ ID ID ID ID ID ID IDprotein NO:) NO:) NO:) NO:) NO:) NO:) NO:) ZFRm1 Right 29 26 25 26 27 28ZFLm1-4 Left 33 30 31 26 32

TABLE 3 ZFN Recognition Sequence F1 F2 F3 F4 F5 F6 ZFLm1 SEQ ID NO: 81SEQ ID SEQ ID NO: SEQ ID NO: SEQ ID SEQ ID SEQ ID (left)GTTGCTCCAGGCCACAGCA NO: 78 77 80 NO: 79 NO: 78 NO: 87 QSGDLTR QWGTRYRERGTLAR RSDNLRE QSGDLTR TSGALTR ZFRm1-4 85 SEQ ID SEQ ID NO: SEQ ID NO:SEQ ID (right) GACTTTGCATGT NO: 82 83 86 NO: 84 WRSSLAS QSGSLTR HKWVLRQDRSNLTR

Construction of Antigen-Expressed K562 Cell Lines

K562 cells were transduced with lentivirus including nucleic acidsequences encoding various antigens (FIG. 39) to establish target tumorcell lines (K562-CD19 tumor cells). The lentivirus included theIRES-mCherry (red) construct, which encodes red fluorescence forconfirmation of antigen expression. Red fluorescent signals wereobserved from these cell lines, indicating that target solid tumor celllines were successfully established (FIG. 39). Techniques ofconstruction of cell lines may be found at “Chimeric ReceptorsContaining CD137 Signal Transduction Domains Mediate Enhanced Survivalof T Cells and Increased Antileukemic Efficacy,” In Vivo MolecularTherapy vol. 17 no. 8, 1453-1464 August 2009, which is incorporatedherein by reference. K562 cells were obtained from American Type CultureCollection (ATCC).

Construction of CAR T Cells

Primary T cells were transduced with lentivirus including various CARsto establish different CAR T cell lines targeting different antigenslisted in Table 1. In some experiments, the lentivirus may include anucleic acid sequences 1-4, or 6 as illustrated in FIG. 23. These cellswere obtained from healthy human donors. The lentivirus included anucleic acid sequence encoding CAR molecules, respectively, and furtherincluded the IRES-mCherry (green) construct, which encodes greenfluorescence for confirmation of CAR expression. Expression of CARs wasmeasured to confirm that CAR T cell lines express specific anti-antigenmolecules. Techniques related to cell cultures, construction oflentiviral vectors, and flow cytometry may be found in “Treatment ofAdvanced Leukemia in Mice with mRNA-Engineered T Cells,” Human GeneTherapy, 22:1575-1586 (December 2011), which is incorporated herein byreference.

T Cell Killing Assay

CAR T cell killing assays were conducted to measure the effectiveness ofCAR T cells. Primary T cells were obtained from blood samples of healthyhuman donors. These T cells were transduced with a nucleic acid sequenceencoding a CAR and with a nucleic acid sequences 1-4, or 6 asillustrated in FIG. 23 (FIGS. 24-26 and 39), and CAR expression on Tcells was measured using flow cytometry techniques.

K562 cells were transduced with nucleic acid sequences encodingcorresponding human antigens, respectively, and antigen expression wasmeasured using flow cytometry techniques. Further antigen-expressionK562 cells were transduced with a nucleic acid sequence encodingfluorescent proteins (RFP) for killing assay analysis. Various CAR Tcells were incubated with corresponding K562 cells for 24 hours invarious E:T ratios (30:1, 10:1, 3:1, 1:1), and red fluorescence signalsfrom cocultured cells were observed.

In Vivo Anti-Tumor Activity

Heterotransplantation of human cancer cells or tumor biopsies intoimmunodeficient rodents (xenograft models) has, for the past twodecades, constituted the major preclinical screen for the development ofnovel cancer therapeutics (Song et al., Cancer Res. PMC 2014 Aug. 21,2159-2169. and Morton et al., Nature Protocols, 2, -247-250 (2007)). Toevaluate the anti-tumor activity of CAT T cells in vivo, immunodeficientmice bearing tumor xenografts were used to evaluate CAR T's anti-tumoractivity.

K562-CD19-RFP cells were used to establish the immunodeficient micebearing CD19 tumor xenografts. On day 120, K562-PRLR-RFP cells wereinjected into tail veins of the immunodeficient mice. On day 122 or 123,irradiation was performed on the immunodeficient mice in 2 Gy fractions.On day three, the formation of tumor cells in the immunodeficient micewas observed.

On day 123, anti-CD19 human CAR T cells (i.e., anti-CD19 CAR T) weretransfused to the immunodeficient mice, and anti-tumor activities wereobserved in the immunodeficient mice. The anti-CD19 CAR T cells weremade by the protocol described in this present disclosure. The presenceof K562-CD19-RFP cells was evaluated using the peripheral blood of theimmunodeficient mice by flow cytometry after three or four weeks aftertransfusion. In control, the buffer was transfused to theimmunodeficient mice, and the immunodeficient mice died within four tosix weeks. As for the immunodeficient mice transfused with anti-CD19 CART, the K562-CD19-RFP cells were not observed, and the immunodeficientmice behaved normally. Human CD3 cells were further observed in theimmunodeficient mice (FIG. 43). It is concluded that CAR proliferable Tcells have anti-tumor activity in mice. Additional information about theprotocol was provided in Table 4 below.

TABLE 4 Tumor cell K562-CD19 RFP cells Tumor cells transplanted5*10{circumflex over ( )}5 cells/mouse irradiation 2Gy CAR T cellsinfused 1*10{circumflex over ( )}7 cells/mouse

Expression of CAR/Antigen on Primary T Cells

Primary T cells were obtained from a patient. The obtained primary Tcells were divided into two groups. Primary T cells in Group 1 weretransduced with lentiviral vectors including a nucleic acid sequenceencoding Anti-TSHR CAR (SEQ ID NO: 49). Primary T cells in Group 2 weretransduced with lentiviral vectors including a nucleic acid sequenceencoding TSHR (SEQ ID NO: 43). Flow-cytometry was performed and analyzedto determine the expression of CAR and TSHR in primary T cells,respectively (FIGS. 45 and 46). Techniques related to cell cultures,construction of lentiviral vectors, and flow cytometry may be found in“Control of large, established tumor xenografts with geneticallyretargeted human T cells containing CD28 and CD137 domains,” 3360-3365PNAS Mar. 3, 2009, vol. 106 no. 9, which is incorporated herein byreference.

In Vivo Cytokine Release Assay

Primary T cells of Group 1 and Group 2 were infused into mice(Experimental Group). As control, Primary T cells of Group 1 alone orbuffer were infused into mice (Control Group 1 and Control Group 2).Several parameters regarding cell infusion are provided in Table 5below. NPG mice were irradiated, and a certain number of CAR T cells andcorresponding control agents were infused into mice. For Control Group2, three consecutive buffers were returned to the mice. For ControlGroup 1, T cells that do not express antigen were returned three timesin succession. For Experimental Group, T cells expressing antigens werecontinuously transfused three times in succession. After the transfusionwas completed, blood from the limbal vein was collected to analyze the Tcells and factor release in the peripheral blood of the mice. The micewere then sacrificed and T ratios of each organ/CAR T Cell ratio/CAR Tcopy and other data were collected. Cytokine release assay was thenperformed. Various cytokines (e.g., IFN-g, IL4, IL2) in mice peripheralblood were measured for Experimental Group and Control Group. As shownin FIGS. 47-49, the amount of cytokine released in the ExperimentalGroup was greater than those in Control Group. These results demonstratethat infusion of cells expressing an antigen enhances the correspondingCAR T cells' T cell response. The schedule for in vivo analysis isprovided in Table 6 below. Further, CAR/CD3 positive cell rates weremeasured, and it was observed that the rates increased in response to Tcells expressing the antigen (FIG. 50). on day 28, the mice weresacrificed, and the number of CAR T cell were measured in mouse spleen.It was observed that the number of CAR T cells in mouse spleen increasedas compared to mice without infusion of T cells expression the antigen(FIG. 51).

TABLE 5 Experimental Group Control Group 1 Control Group 2 Anti-TSHR CART Anti-TSHR CAR T Anti-TSHR CAR T cells about 4 × cells about 4 × cellsabout 4 × 10⁶/mouse 10⁶/mouse 10⁶/mouse Antigen T (TSHR- NT(non-transduced T NT (non-transduced T overexpressed T cell) cell) about4 × cell) about 4 × about 4 × 10⁶/mouse per time 10⁶/mouse per time10⁶/mouse per time

TABLE 6 Day 1 Day 3 Day 5 Day 9 Day 12 Day 14 Day 21 Day 28 irradiationanti-TSHR buffers/nt/ buffers/nt/ buffers/nt/ bleeding bleedingsacrifice at 1.5 Gy CAR T cells antigen antigen antigen and and andinfusion T infusion T infusion T infusion analysis analysis analysis

As described above, the treatment methods described herein can easily beadapted for other species or subjects, such as humans.

All publications, patents and patent applications cited in thisspecification are incorporated herein by reference in their entiretiesas if each individual publication, patent or patent application werespecifically and individually indicated to be incorporated by reference.While the foregoing has been described in terms of various embodiments,the skilled artisan will appreciate that various modifications,substitutions, omissions, and changes may be made without departing fromthe spirit thereof.

What is claimed is:
 1. A method comprising: providing T cells comprisinga chimeric antigen receptor (CAR); and culturing the T cells in thepresence of an agent that an extracellular domain of the CAR binds toobtain CAR T cells.
 2. The method of claim 1, wherein the agent bindsthe extracellular domain of the CAR and mediates a response by the Tcells comprising the CAR.
 3. The method of claim 1, wherein the agent isan extracellular domain of the antigen.
 4. The method of claim 3,wherein the antigen is Epidermal growth factor receptor (EGFR), VariantIII of the epidermal growth factor receptor (EGFRvIII), Human epidermalgrowth factor receptor 2 (HER2), Mesothelin (MSLN), Prostate-specificmembrane antigen (PSMA), Carcinoembryonic antigen (CEA),Disialoganglioside 2 (GD2), Interleukin-13Ra2 (IL13Rα2), Glypican-3(GPC3), Carbonic anhydrase IX (CAIX), L1 cell adhesion molecule(L1-CAM), Cancer antigen 125 (CA125), Cluster of differentiation 133(CD133), Fibroblast activation protein (FAP), Cancer/testis antigen 1B(CTAG1B), Mucin 1 (MUC1), Folate receptor-α (FR-α), CD19, FZD10, TSHR,PRLR, Muc 17, GUCY2C, CD207, CD3, CD5, B-Cell Maturation Antigen (BCMA),or CD4.
 5. The method of claim 1, wherein a ratio of an amount of theagent and a number of the CAR T cells after culturing with the agent is1:5000 to 1:5 (μg/10⁴ cell).
 6. The method of claim 1, wherein aconcentration of the agent in a culture media is 2 to 10⁴ ng/ml.
 7. Themethod of claim 1, wherein providing the T cells comprising the CARcomprises culturing the T cells without the agent for at least 8 daysafter introduction of a vector comprising a nucleic acid sequenceencoding the CAR into the T cells, and culturing the T cells in thepresence of the agent comprises culturing the T cells after the at least8 days.
 8. The method of claim 1, wherein a ratio of a number of the CART cells expressing the CAR and the T cells not expressing the CAR isgreater than the ratio when the cells are cultured without the agent. 9.The method of claim 1, wherein the CAR comprises an extracellulardomain, a spacer domain, a transmembrane domain, and an intracellulardomain.
 10. The method of claim 9, wherein the spacer domain of the CARcomprises an amino acid sequence of SEQ ID NO.: 68 or
 69. 11. The methodof claim 9, wherein the transmembrane domain of the CAR comprises anamino acid sequence SEQ ID NO.: 72 or 75 and the spacer domain of theCAR comprises an amino acid sequence of SEQ ID NO.:
 68. 12. The methodof claim 1, wherein the agent comprises an extracellular domain of atleast one of CD19, FZD10, TSHR, PRLR, Muc 17, GUCY2C, CD207, CD3, CD5,or CD4.
 13. The method of claim 1, wherein the agent comprises at leastone of amino acid sequences: SEQ IDs: 18-27.
 14. The method of claim 1,wherein the agent comprises at least one of GCC, B7-H4, Prostatespecific membrane antigen (PSMA), Carcinoembryonic Antigen (CEA),IL13Ralpha, her-2, CD19, CD20, CD22, CD123, NY-ESO-1, HIV-I Gag, LewisY, Mart-I, gplOO, tyrosinase, WT-I, h TERI, MUC16, mesothelin, MIC-A,MIC-B, estrogen, progesterone, RON, or one or more members of theULBP/RAETI family.
 15. The method of claim 1, wherein the CAR comprisesan extracellular domain, a transmembrane domain, and an intracellulardomain comprising a CD3-zeta signaling domain and a signaling domain ofa costimulatory molecule.
 16. The method of claim 1, wherein the T cellsare derived from a healthy donor and elicit no graft-versus-host disease(GVHD) response or a reduced GVHD response in a human recipient ascompared to the GVHD response elicited by a primary human T cellisolated from the same human donor and having no reduced expression ofendogenous TCR gene and/or HLA I.
 17. The method of claim 1, wherein theT cells comprise a nucleic acid sequence encoding hTERT, a nucleic acidencoding SV40LT, or a combination thereof.
 18. The method of claim 1,wherein the agent is a soluble antigen generated by a eukaryotic systemor a bacterial expression system.
 19. A pharmaceutical compositioncomprising the CAR T cells obtained by the method of claim
 1. 20. Amethod for treating cancer, the method comprising administering aneffective amount of the pharmaceutical composition of claim 19 to asubject in need thereof.